Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy

Smets, Koenraad; Coen, Kris De; Dhooge, Ingeborg; Standaert, Lieve; Laroche, Sabrina; Mahieu, Ludo; Logghe, N.; Cossey, Veerle; Boudewyns, An

doi:10.1007/s00431-006-0192-2

Cited by 45 publications

(28 citation statements)

References 37 publications

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“…Currently, antiviral treatment with ganciclovir or valganciclovir is recommended only for symptomatic newborns with severe symptomatic focal organ disease or central nervous system involvement. [109][110][111][112] The remainder could be enrolled in a longitudinal follow-up program to detect delayed-onset or progressive hearing loss and other developmental delays. Early detection of hearing loss leads to early intervention and better patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hearing Loss and Congenital CMV Infection: A Systematic Review

Goderis¹,

Leenheer²,

et al. 2014

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BACKGROUND AND OBJECTIVE: Hearing loss caused by congenital cytomegalovirus (cCMV) infection was first observed in 1964. Today cCMV is the most common cause of nonhereditary sensorineural hearing loss in childhood. Our objective was to provide an overview of the prevalence of cCMV-related hearing loss, to better define the nature of cCMV-associated hearing loss, and to investigate the importance of cCMV infection in hearing-impaired children. METHODS:Two reviewers independently used Medline and manual searches of references from eligible studies and review articles to select cohort studies on children with cCMV infection with audiological follow-up and extracted data on population characteristics and hearing outcomes. RESULTS:Thirty-seven studies were included: 10 population-based natural history studies, 14 longitudinal cohort studies, and 13 retrospective studies. The prevalence of cCMV in developed countries is 0.58% (95% confidence interval, 0.41-0.79). Among these newborns 12.6% (95% confidence interval, 10.2-16.5) will experience hearing loss: 1 out of 3 symptomatic children and 1 out of 10 asymptomatic children. Among symptomatic children, the majority have bilateral loss; among asymptomatic children, unilateral loss predominates. In both groups the hearing loss is mainly severe to profound. Hearing loss can have a delayed onset, and it is unstable, with fluctuations and progression. Among hearing-impaired children, cCMV is the causative agent in 10% to 20%. Despite strict selection criteria, some heterogeneity was found between selected studies.CONCLUSIONS: This systematic review underscores the importance of cCMV as a cause of sensorineural hearing loss in childhood. Pediatrics 2014;134:972-982

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Section: Discussionmentioning

confidence: 99%

Hearing Loss and Congenital CMV Infection: A Systematic Review

Goderis¹,

Leenheer²,

et al. 2014

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“…All infants who received treatment, with the exception of the false-positive HSV, had additional laboratory or physical examination findings suggesting infection. Previous studies on the treatment of congenital CMV support this and have focused on treating those who were symptomatic with microcephaly, seizures, CSF abnormalities, CNS imaging abnormalities, hearing loss, or chorioretinitis [15]. Our study suggests that routine screening for TORCH infections should be limited to neonates with additional findings besides SGA status.…”

Section: Discussionmentioning

confidence: 83%

The C in TORCH: A Cost-Effective Alternative to Screening Small-for-Gestational-Age Infants

2014

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Background: Infants born with birth weights under the 10th percentile for their gestational age are classified as small for gestational age (SGA). TORCH infections are reported to be associated with SGA infants. With the low incidence of infections, screening is likely to be expensive and of low utility. Objective: The objective of this study was to determine the utility and cost-effectiveness of screening SGA infants with TORCH serology titers, urine cytomegalovirus (CMV) cultures and cranial ultrasounds. Methods: A retrospective review was conducted on all infants admitted to the neonatal intensive care unit (NICU) at Los Angeles County and University of Southern California (LAC+USC) Medical Center from January 2003 to December 2011 with a diagnosis of SGA or intrauterine growth restriction. Birth characteristics such as birth weight, length, head circumference and gestational age were recorded. TORCH titer results, urine CMV results and cranial ultrasound findings were collected. Results: Between 2003 and 2011, 232 SGA infants were admitted to the NICU at LAC+USC Medical Center. Of these, 117 infants (50%) had TORCH titer testing performed; there was only 1 positive CMV IgM and 1 positive HSV IgM result. Repeat urine CMV testing was performed on 109 infants (47%), with a total of 296 urine CMV samples collected from these infants; 6 infants had positive results, of whom 3 had repeat positive urine CMV samples. Overall, 149 of the infants had a cranial ultrasound done, none of which were positive for calcifications. Conclusions: TORCH titer testing, urine CMV screening and cranial ultrasound screening are of low yield in screening clinically asymptomatic SGA infants for TORCH infections. Given the low number of positive results, a cost-effective alternative of selective TORCH testing may be limited to infants with additional clinical findings. This study serves as a reminder to periodically examine testing practices and patient population to maximize cost-effectiveness.

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“…Letter to the editor: We fully support the article and conclusions published in this month's online European Journal of Pediatrics [3] regarding the use of ganciclovir/valganciclovir (GCV/ VGCV) in neonates. In particular, the proper monitoring of potentially mutagenic drugs is long overdue.…”

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confidence: 71%