Background: Recently, valganciclovir treatment of symptomatic congenital cytomegalovirus (cCMV) disease, which was started during the neonatal period (≤4 weeks), was found to improve hearing and developmental outcome. However, not all children with symptomatic cCMV are identified during their first weeks of life. Moreover, approximately 10% who are asymptomatic at birth will have hearing deterioration later in life and would have benefited from earlier treatment.
Methods Data were collected from all infants with cCMV infection who began treatment after the first 4 weeks of life.
Results Ninety-one children started antiviral treatment beyond 4 weeks of age; 66/298 (22.2%) were symptomatic and 25/217 (11.5%) asymptomatic. Treatment was initiated on average at 14 weeks of age (range 5-77 weeks) and at 53.3 weeks (range 12-156 weeks) in each group. Of the 45 affected ears in the symptomatic group at baseline, 30 (66.7%) improved and only 2 (4.4%) deteriorated, with most of the improved ears (27/30=90%) returning to normal hearing. In the asymptomatic group, late onset treatment was initiated upon detection of hearing impairment. Out of the 42 deteriorated ears, 38 (90.5%) improved after at least one year of follow-up. Hematological adverse events, ie neutropenia, were noted in a minority of cases (4.4%).
Conclusions Our study demonstrates the benefits as well as the safety aspects of treating symptomatic children with cCMV even beyond the recommended neonatal period as well as to those who were asymptomatic at birth but experienced hearing deterioration soon after.
