From the Guidelines
Infants with congenital cytomegalovirus (CMV) infection should receive comprehensive follow-up care, including regular hearing assessments, developmental evaluations, and ophthalmologic examinations, as well as consideration of antiviral treatment with valganciclovir for symptomatic cases, as recommended by the American Cochlear Implant Alliance position statement on newborn congenital CMV screening 1.
Follow-up Care
The follow-up care for congenital CMV infection should include:
- Hearing assessments every 6 months until age 3, then annually until adolescence, to monitor for potential hearing loss, which can develop or progress over time 1
- Regular developmental evaluations at 6,12,18, and 24 months, then annually, to assess for cognitive, motor, and language delays
- Ophthalmologic examinations at diagnosis, 6 months, 12 months, and then annually, to monitor for retinitis or visual impairments
Antiviral Treatment
For symptomatic infants, antiviral treatment with valganciclovir (16 mg/kg/dose twice daily for 6 months) should be considered to improve hearing and developmental outcomes, as supported by a randomized controlled trial that found a 6-month course of valganciclovir modestly improved developmental outcomes 2 years after treatment 1
Additional Care
Additional members of the child's optimal clinical team should include otolaryngology, audiology, ophthalmology, and speech-language pathology, as well as other specialists such as a developmental pediatrician, neurologist, and physical therapist as warranted on an individual basis 1
Laboratory Monitoring
Laboratory monitoring during treatment should include complete blood counts every 2 weeks for the first month, then monthly, as well as liver function tests and kidney function assessment
Neuroimaging
Neuroimaging with head ultrasound or MRI is recommended at diagnosis to detect brain abnormalities, which can be associated with congenital CMV infection 1
From the Research
Follow-up for Congenital Cytomegalovirus (CMV) Infection
The follow-up for Congenital Cytomegalovirus (CMV) infection involves various aspects, including:
- Ophthalmological evaluations: Infants with symptomatic CMV infection should undergo neonatal and periodical ophthalmological evaluations throughout childhood, as ophthalmological abnormalities are common in symptomatic infants and often correlate with central nervous system (CNS) involvement 2.
- Audiological follow-up: The general recommendation is to evaluate hearing in all children with congenital CMV at intervals of 3-6 months up to 1 year of age, 6 months from 1 to 3 years of age, and once a year from 3 to 6 years of age 3.
- Vestibular follow-up: There are no universally accepted protocols for vestibular follow-up, but video head impulse test (v-HIT) and cervical vestibular-evoked myogenic potentials (cVEMPs) are sometimes used 3.
- Antiviral treatment: Antiviral treatment is recommended for symptomatic newborns with congenital CMV infection, with valganciclovir monotherapy being a preferred option due to its effectiveness in reducing viral load and shortening hospital stays 4.
- Long-term treatment: Prolonged therapy with intravenous ganciclovir followed by oral valganciclovir appears to lead to better auditory outcomes than short-term treatment 5.
Key Considerations
- Early identification of infected children is critical to improve outcomes by providing timely interventions and guidance for long-term follow-up 6.
- Personalized follow-up protocols based on risk factors, such as the trimester of maternal infection and CMV PCR results in amniotic fluid, may allow for more precise evaluations and optimized resource allocation 3.
- The type of antiviral treatment and its duration should be determined based on the individual child's needs and response to treatment 4, 5.