From the Guidelines
Infants with congenital cytomegalovirus (CMV) infection should be isolated to prevent transmission to others, with standard precautions and contact precautions implemented, particularly when handling bodily fluids, as recommended by recent guidelines 1. The isolation precautions are crucial to prevent the transmission of CMV to others, especially immunocompromised individuals and developing fetuses.
- Standard precautions should be implemented, with particular emphasis on hand hygiene before and after contact with the infant.
- Contact precautions are also recommended when handling the infant's bodily fluids, especially urine and saliva, which can shed virus for prolonged periods (up to 2-3 years) 1.
- Healthcare workers should wear gloves, gowns, and masks when performing procedures that might generate splashes.
- Pregnant healthcare workers should be informed about the risk of CMV transmission and may be reassigned from caring for these infants if possible, particularly if they are CMV-seronegative.
- Family members should be educated about proper handwashing after diaper changes and contact with the infant's secretions. The isolation period typically continues until the infant is no longer shedding virus, which may require periodic testing of urine or saliva samples for CMV 1. It is also essential to provide comprehensive care to infants with congenital CMV infection, including referrals to related professionals, such as otolaryngology, audiology, ophthalmology, and speech-language pathology, to complete a baseline assessment soon after identification and characterize the extent of the disease 1.
From the Research
Congenital CMV Infection Treatment
- The treatment of congenital CMV infection typically involves the use of antiviral medications such as valganciclovir or ganciclovir 2, 3, 4.
- Valganciclovir is often preferred due to its oral formulation and better bioavailability compared to ganciclovir 5.
- The duration of treatment can vary, but a 6-month course is commonly recommended for symptomatic infants 2, 3, while some studies suggest a 12-month treatment duration may be more effective for hearing and neurodevelopmental outcomes 4.
Adverse Events and Monitoring
- Neutropenia is a common adverse event associated with valganciclovir and ganciclovir treatment, and regular monitoring of white blood cell counts is necessary 2, 3, 5.
- Anemia and thrombocytopenia can also occur, and hemoglobin levels should be closely monitored 2.
- The development of resistance to antiviral medications is a concern, and regular viral load monitoring is essential to identify emerging resistance 6.
Diagnosis and Treatment Approach
- A PCR assay in blood, urine, and saliva is recommended for diagnosing congenital CMV infection in neonates 4.
- Antiviral therapy is typically reserved for symptomatic infants, and the decision to treat should be based on individual patient factors and the presence of symptoms such as microcephaly, intracranial calcifications, or sensorineural hearing loss 4.