Congenital Cytomegalovirus Disease

Symptomatic congenital CMV disease  

Diagnosed based on detection of CMV in the urine or saliva within the first 3 weeks of life 
 
WITH  

Symptoms:  

Moderately to severely symptomatic: 

Multiple manifestations attributable to CMV infection: thrombocytopenia, petechiae, hepatomegaly, splenomegaly, intrauterine growth restriction, hepatitis 
 
OR  

CNS involvement such as microcephaly, radiographic abnormalities consistent with CMV-related CNS disease (ventriculomegaly, calcifications, periventricular echogenicity, cortical or cerebellar malformations), abnormal CSF indices for age, chorioretinitis, or detection of CMV DNA in CSF  

See 2nd column for continued categories 

Cytomegalovirus 

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Symptom classification continued from 1st column:  

Mildly symptomatic: 

1-2 isolated manifestations that are mild and transient, occurring in isolation (e.g. single measurement of low platelet count) 

Asymptomatic congenital CMV infection with isolated sensorineural hearing loss (SNHL):  

Sensorineural hearing loss, with no other apparent abnormalities 

Asymptomatic congenital CMV infection: 

No apparent abnormalities to suggest congenital CMV disease, and normal hearing 

Asymptomatic with normal hearing:  
Treatment not recommended  

Mildly symptomatic, or asymptomatic with isolated SNHL, or diagnosed after first month of life: 
Current guidelines do not recommend  treatment routinely. Consult ID for individualized assessment.  

Moderate to severely  symptomatic, within first month of life, gestational age >= 32 weeks:  

Valganciclovir  
16 mg/kg/dose enterally bid 

Adjust dose monthly to account for weight gain 

Moderate to severely  symptomatic, within first month of life, gestational age <32 weeks: 
Consult ID for individualized management & medication dosing 

Unable to take enteral medication: 

Ganciclovir  

6 mg/kg/dose IV q12h  

ID consult recommended. Multiple follow-up evaluations are recommended, recommendations here focused on treatment with antivirals only 

Monitoring During Therapy:  
Absolute neutrophil count weekly x 6 weeks, at 8 weeks, then monthly for duration of therapy 

AND 

AST, ALT monthly 

Duration: 6 months