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Congenital Cytomegalovirus Infection: Time to Test Newborns?

by Jennifer L.W. Fink •

Education, an important part of the Utah law, may help prevent CMV-associated cases of SNHL in the future, because a child with CMV can shed the virus for years. Teaching families and childcare providers how to prevent CMV transmission (good hand washing, toy sanitation, not sharing utensils) may decrease future congenital CMV infections and CMV-related SNHL, said Dr. Park.

Treatment with antiviral medication can preserve, slow, or even reverse CMV-related SNHL (J Clin Virol. 2012;55:72-74; J Nippon Med Sch. 2012;79:471-477; J Pediatr. 2003;143:16-25.) “In some cases, we can actually bring back the hearing,” Dr. Choo said.

Drs. Choo and Park both treat patients with valganciclovir, an oral antiviral medication. (Valganciclovir is not FDA-approved for the treatment of congenital CMV; using it to treat CMV and hearing loss is an off-label use.) To be effective, though, the drug must be administered as early as possible. “If you catch the hearing loss within the first several weeks of onset, you have a much better chance of rescuing the hearing,” Dr. Choo said. “If you are several months into the hearing loss, it starts to get grey as to whether you’re too late, and if you’re a year or more out, most people would be fairly skeptical.”

Infants being treated with valganciclovir for congenital CMV-related hearing loss need frequent audiologic monitoring. “Typically, we confirm hearing loss, start them on valganciclovir, and then see them about every four to six weeks to repeat an auditory brainstem response test,” said Margaret Kenna, MD, MPH professor of otology and laryngology at Harvard Medical School in Boston. Children with CMV should also be referred to infectious disease, neurology, and ophthalmology specialists for further evaluation and monitoring.

Antiviral Therapy for CMV

A 2003 study found that six weeks of treatment with IV valganciclovir was effective in preventing hearing loss and improving auditory outcomes for infants with congenital CMV (J Pediatr. 2003;143:16-25). The latest research suggests that six months of oral valganciclovir may be both more convenient and more effective.

The yet-to-be-published study, which was presented at IDWeek2013, held October 2-5 in San Francisco, compared the effectiveness of six weeks of IV treatment with six months of oral treatment. Infants who received six months of oral valganciclovir were more likely to show improvements in hearing than infants who received just six weeks of treatment. Improvements continued until 24 months of age.

Should CMV Testing Be Performed on All Infants?

Currently, Utah only performs CMV testing on children who have failed their hearing screenings. The problem with this approach is that about half of all babies with congenital CMV pass their screenings and show no signs of infection, said McVicar.