[Therapy Options for Infants with Congenital Cytomegalovirus Infection - Implications for Setting Up Neonatal Screening Programs].

Abstract

INTRODUCTION:

The number of diseases covered by universal neonatal screening in Germany has risen steadily from 1 (phenylketonuria) in 1968 to 17 (with hearing impairment and congenital hip dysplasia) in 2018. Treatment, however, of disorders diagnosed by screening may harm children, as failed neuroblastoma screening has shown. There are several pilot studies to detect congenital cytomegalovirus (CMV) infection but no consensus as to the treatment of the infants identified.

METHODOLOGY:

Systematic search for studies investigating therapy of congenital CMV infection, using PubMed and the WHO International Clinical Trials Registry Platform (ICTRP).

RESULTS:

We found only one controlled trial that randomized infants with symptomatic congenital CMV infection (involving the central nervous system) to treatment (intravenous ganciclovir for 6 weeks) or no treatment. Treatment was associated with significantly less hearing deterioration. A second trial comparing 6 weeks vs. 6 months of treatment with valganciclovir, an oral prodrug of ganciclovir, found no benefit for hearing but modestly improved developmental outcomes associated with 6 months of treatment. In contrast, an open-label registry reported benefits for infants with congenital CMV infection and isolated hearing who received valganciclovir for 12 months, with hearing improvement in 2/3 of cases after a median follow-up of 4½ years.

CONCLUSIONS:

Antiviral treatment of neonates with congenital CMV infection and few symptoms including isolated hearing loss remains controversial. A generally accepted therapy, however, is pivotal before introducing universal or targeted screening for congenital CMV infection.

• Authors: Christoph Bührer, Oliver Blankenstein, Rainer Rossi, für die Screeningkommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin (Mitglieder am Ende des Artikels)
• Journal: Zeitschrift fur Geburtshilfe und Neonatologie (Z Geburtshilfe Neonatol) Vol. 224 Issue 2 Pg. 71-78 (Apr 2020) ISSN: 1439-1651 [Electronic] Germany
• Vernacular Title: Therapeutische Optionen bei konnataler Zytomegalievirus (CMV)-Infektion – Implikationen für die Einführung eines Screeningprogramms.
• PMID: 31426118 (Publication Type: Journal Article, Systematic Review)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Antiviral Agents
• Ganciclovir

Topics

• Antiviral Agents (adverse effects, therapeutic use)
• Child
• Cytomegalovirus Infections (complications, congenital, drug therapy)
• Ganciclovir (adverse effects, therapeutic use)
• Germany
• Hearing Loss, Sensorineural (complications, drug therapy, virology)
• Humans
• Infant
• Infant, Newborn
• Neonatal Screening (methods)
• Treatment Outcome