Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy.
OBJECTIVE
The objective of this study is to look for evidence based or scientific guidelines for selection of newborns with congenital cytomegalovirus (CMV) infection that might benefit from treatment with ganciclovir.


METHODS
A literature search was conducted involving the MEDLINE database and the Cochrane Collaboration Library. Abstracts were reviewed to select pertinent articles dealing with ganciclovir therapy in neonates. References from selected articles as well as from reviews were screened for additional relevant articles. In total, 13 case reports (16 patients in all), three descriptive uncontrolled studies (20 patients in all), two randomized dose-comparative studies (54 patients in all) and one randomized controlled study (42 patients) were identified.


METHODS
All reported patients presented with central nervous system manifestation of CMV infection. Only the randomized controlled study showed a reduction of hearing deterioration in the treated group. Published predictors of hearing loss in congenitally CMV infected children allow identification of candidates that might benefit from treatment. Studies so far are promising but of insufficient number to make evidence based recommendations about indications for treatment of congenital CMV. As such, studies are very difficult to conduct and treatment of infants at high risk of hearing loss may appear justified. There is scientific data to help clinicians in selecting a subgroup of infants that is at higher risk of hearing deterioration and therefore might benefit the most from ganciclovir therapy.
Smets
Koenraad
K
Neonatal Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. koenraad.smets@UGent.be
De Coen
Kris
K
Dhooge
Ingeborg
I
Standaert
Lieve
L
Laroche
Sabrina
S
Mahieu
Ludo
L
Logghe
Noël
N
Cossey
Veerle
V
Boudewyns
An
A
D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000188:drug therapy*; D015774:Ganciclovir / Q000627:therapeutic use*; D006319:Hearing Loss, Sensorineural / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018579:Patient Selection
D000998:Antiviral Agents; D015774:Ganciclovir