title: Ganciclovir treatment in infants with cytomegalovirus infection and cholestasis.
abstract: BACKGROUND
  The authors have previously described an association between cytomegalovirus (CMV) infection and intrahepatic and extrahepatic forms of neonatal cholestasis. Pediatric use of the antiviral drug ganciclovir to treat patients with CMV infection has increased. In this study, infants with CMV infection and cholestasis were treated with ganciclovir.
  
  
  METHODS
  Six infants with cholestasis (age, 3-16 weeks) and with signs of ongoing CMV infection were treated with intravenous ganciclovir for 3 to 7 weeks and observed for 4 to 31 months after treatment. Two patients had biliary atresia, one had suspected septo-optic dysplasia and three had no obvious cause for intrahepatic cholestasis other than ongoing CMV infection.
  
  
  RESULTS
  Four patients, including one with biliary atresia, responded to the treatment, whereas two patients, including the one with septo-optic dysplasia did not. The latter patient had episodes of symptomatic hypoglycemia during the treatment, which was subsequently stopped. Liver function at the end of follow-up was good in four patients, intermediate in one, and poor in one.
  
  
  CONCLUSIONS
  Ganciclovir treatment may be beneficial in infants with CMV-associated intrahepatic cholestasis, but controlled studies are needed. Because of the possible side effect of hypoglycemia, infants with cholestasis who have increased risk for such episodes should not be treated.
authors.affiliation: Department of Pediatrics, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. bjorn.fischler@pediat.hs.sll.se
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Casswall
authors.forename: Petter
authors.initials: P
authors.lastname: Malmborg
authors.forename: Antal
authors.initials: A
authors.lastname: Nemeth
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications / Q000188:drug therapy*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D008099:Liver / Q000473:pathology / Q000821:virology; D008111:Liver Function Tests; D008137:Longitudinal Studies; D008297:Male; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D015774:Ganciclovir