title: Treatment of symptomatic congenital cytomegalovirus infection beyond the neonatal period.
abstract: BACKGROUND
  Congenital cytomegalovirus (CMV) is an important cause of sensorineural hearing loss. Ganciclovir treatment in the neonatal period may prevent hearing deterioration in infants with central nervous system (CNS) involvement. However, there are hardly any data regarding antiviral treatment begun beyond the neonatal period.
  
  
  OBJECTIVE
  To describe the hearing outcome of infants with congenital CMV infection and CNS involvement treated beyond the neonatal period. To assess the tolerability and toxicity of prolonged valganciclovir treatment in these patients.
  
  
  METHODS
  Retrospective case series of infants with congenital CMV infection and CNS involvement who started antiviral treatment beyond the neonatal period in Spain between 2008 and 2010. Hearing was tested by brainstem-evoked response at the time of diagnosis, 6 and 12 months after the beginning of treatment.
  
  
  RESULTS
  Thirteen cases were included. All received oral valganciclovir, and 4 also intravenous ganciclovir. Median valganciclovir treatment duration was 6 months and it was well tolerated. Six patients developed neutropenia, none requiring granulocyte colony-stimulating factor. Eleven children (85%) had hearing defects at baseline, compared to 50% at 12 months. By ears, 18 ears showed hearing loss at baseline (7 mild, 3 moderate, 8 severe). At 12 months, 9 remained stable, 7 had improved and none had worsened. In 8 normal ears at baseline, no deterioration was found at 12 months.
  
  
  CONCLUSIONS
  Valganciclovir treatment is well tolerated. It may improve or preserve the auditory function of congenitally cytomegalovirus-infected patients treated beyond the neonatal period for at least one year after the beginning of antiviral treatment.
authors: Department of Pediatrics, Hospital La Paz, Paseo de la Castellana 268, 28046 Madrid, Spain. teredelrosal@yahoo.es
authors: Teresa
authors: T
authors: del Rosal
authors: Fernando
authors: F
authors: Baquero-Artigao
authors: Daniel
authors: D
authors: Blázquez
authors: Antoni
authors: A
authors: Noguera-Julian
authors: David
authors: D
authors: Moreno-Pérez
authors: Alejandro
authors: A
authors: Reyes
authors: Javier
authors: J
authors: Vilas
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000097:blood / Q000151:congenital* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006319:Hearing Loss, Sensorineural / Q000821:virology; D006801:Humans; D007223:Infant; D009503:Neutropenia / Q000821:virology; D012189:Retrospective Studies; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir