Keep an eye out for congenital cytomegalovirus

When discussing early-in-life infectious disease, much focus is devoted to neonatal herpes or group B strep sepsis. However, those conditions affect 1500 and 2200 babies each year, respectively. Less attention is paid to congenital cytomegalovirus, which is the most frequent in utero infection in the United States, and affect 12,000 to 27,000 babies born each year. In his presentation “Tips for screening and managing congenital cytomegalovirus” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, David W. Kimberlin, MD, FAAP, professor of pediatrics at the University of Alabama at Birmingham, spoke about screening and managing the condition.

To make a diagnosis of congenital cytomegalovirus, clinicians need to test for it within the first 3 to 4 weeks of life, said Kimberlin. Testing can be done on either urine or saliva. Postnatal infection with cytomegalovirus can occur early through either breastmilk or saliva from kissing. As of right now, most screening for congenital cytomegalovirus is targeted and occurs after the baby has failed his or her newborn screening test. However, the targeted screening can miss babies who are asymptomatic, but destined for some form of hearing loss at some time in their life. Kimberlin advocated for universal screening for congenital cytomegalovirus. He predicated his advocacy on the fact that of the roughly 20,000 children with congenital cytomegalovirus, every year 90% of those children are asymptomatic. Among those asymptomatic cases, most of those children pass the initial hearing screenings and the potential risk of hearing loss is missed. For babies who are found to have the infection, it’s recommended that they are tested for hearing at 4, 6, 8, 12, 15, 18, 24, and 30 months of age, in addition to the recommended standard hearing assessments at 4, 5, 6, 8, and 10 years of age.

Kimberlin also discussed treating congenital cytomegalovirus with ganciclovir and valganciclovir, which he noted at the beginning of his presentation were unapproved uses for the drug, to mitigate hearing loss. Ganciclovir has known toxicities such as bone marrow suppression and neutropenia. In a study that looked at change of hearing between birth and ≥ 1 year of age, children who were given ganciclovir saw either normal hearing remain or had improvement in 48% of the participants. Among the participants who received no treatment, the rate was 22%. Another study examined the effect of longer treatment utilizing valganciclovir, among participants who received treatment for 6 months, 73% had normal hearing remain or improve, in comparison to 57% of participants who received just 6 weeks of treatment. The study also examined developmental outcomes and found that participants who had the treatment for 6 months displayed better outcomes than those who had 6 weeks of treatment.