Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
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Randomized Controlled Trial
Neurodevelopmental outcomes following ganciclovir therapy in symptomatic congenital cytomegalovirus infections involving the central nervous system.
Ganciclovir protects against hearing deterioration in infants with symptomatic congenital cytomegalovirus (CMV) disease involving the central nervous system (CNS). ⋯ Infants with symptomatic congenital CMV involving the CNS receiving intravenous ganciclovir therapy have fewer developmental delays at 6 and 12 months compared with untreated infants. Based on these data as well as the previously published data regarding ganciclovir treatment and hearing outcomes, 6 weeks of intravenous ganciclovir therapy can be considered in the management of babies with symptomatic congenital CMV disease involving the CNS. If treatment is initiated, it should be started within the first month of life and patients should be monitored closely for toxicity, especially neutropenia. Since existing data only address the treatment of symptomatic congenital CMV disease involving the CNS, these data cannot be extrapolated to neonates with other manifestations of CMV disease, including asymptomatic babies and symptomatic babies who do not have CNS involvement.
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A primary maternal infection with cytomegalovirus (CMV) either during or just before pregnancy accounts for the majority of congenital infections where the baby is symptomatic at birth. Following a primary maternal infection, depending on gestational age, between one quarter and three quarters of fetuses will become infected, and approximately one-third of infected fetuses will have symptoms at birth. Experiments using animal models of CMV infection and observational studies in humans indicate that administration of a CMV hyperimmune globulin (HIG) to the pregnant woman with a primary CMV infection should be effective for both the treatment and prevention of fetal infection. The HIG probably acts by reducing placental inflammation, neutralizing virus with high avidity antibodies, and perhaps by reducing cytokine mediated cellular immune responses.