I 'm not sure about best practice in congenital CMV infection of preterms. If the baby has thrombocytopenia ( 50.000-60.000 per mm3 peristent, periventricular leucomalasia, but baby looks good, no pneumonia, no septic appearance, normal CSF findings, no chorioretinitis. What is your option about this patient? drug or not?

Another patient, baby has cholestasis Direct bil: 7.2 mg/dl ALT:65 U/ml acholic gaita. No thrombocytopenia, no peumonia, no septic appearance. Therapy or not?

Dear Rahmi Ors,

CMV and preterm infants - that's a 1-million dollar question, I think!

The rate of transmission (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11229670&query_hl=5&itool=pubmed_docsum)

is high during neonatal care if the infant is given mothers breast milk. It is not always easy to disentangle what lab results and clinical signs are related to a positive CMV-test, for example in urine.

I would not say that we have a clear practise about CMV in our unit, however, it there are multiple findings indicating CMV (other inflam/infect unlikely) including a CMV-positive CSF, we would probably favour treatment.

Anyone who would like to comment in this question?

PCR from blood, urine or CNS will cofirm the diagnosis of CMV congenital infection. Ganciclovir is a very powerful drug to the infection and to the baby. More than 50% will result in neutropenia and trombocytopenia with a dose of 12 mg/kg/d. Probably concomitant use of immunoglobulin-CMV monoclonal would be a gain. There is no experience in congenital CMV with famciclovir PO. Ernani Miura, Porto Alegre, Brazil.

While cruising the net, I came across a few nice articles (free of course) on CMV.

1. Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin. Microbiol. Rev. 2002 Oct ;15(4):680-715.

LINK TO THIS FREE ARTICLE

2. Scanga L, Chaing S, Powell C, Aylsworth AS, Harrell LJ, Henshaw NG, et al. Diagnosis of human congenital cytomegalovirus infection by amplification of viral DNA from dried blood spots on perinatal cards. The Journal of Molecular Diagnostics: JMD. 2006 May ;8(2):240-5.

ABSTRACT

... Our findings suggest that it is possible to diagnose congenital HCMV infection using dried blood collected up to 20 months earlier. ...

LINK TO THIS FREE ARTICLE

3. Meier J, Lienicke U, Tschirch E, Krüger DH, Wauer RR, Prösch S. Human Cytomegalovirus Reactivation during Lactation and Mother-to-Child Transmission in Preterm Infants. J Clin Microbiol. . 2005 Mar ;43(3):1318–1324.

ABSTRACT

...In summary, our study confirmed a very high incidence of HCMV reactivation in mothers during lactation and a significant risk of transmission to preterm infants with the possibility of severe disease in these babies.

LINK TO THIS FREE ARTICLE

4.Ozkan TB, Mistik R, Dikici B, Nazlioglu HO. Antiviral therapy in neonatal cholestatic cytomegalovirus hepatitis. BMC Gastroenterol. . 2007 ;79.

ABSTRACT

...The clinical spectrum of perinatal infection varies from an asymptomatic infection or a mild disease to a severe systemic involvement, including central nervous system. The treatment in the early period of infection improved serologic markers and cholestatic parameters significantly. Further studies will lead us to clarify the efficacy of ganciclovir treatment in the early period of cytomegalovirus hepatitis, and the preventive role of anti-viral therapy on progressive liver disease due to cholestasis and hepatitis in neonatal cytomegalovirus infection.

LINK TO THIS FREE ARTICLE

5. Nozawa N, Koyano S, Yamamoto Y, Inami Y, Kurane I, Inoue N. Real-Time PCR Assay Using Specimens on Filter Disks as a Template for Detection of Cytomegalovirus in Urine . J Clin Microbiol. . 2007 Apr ;45(4):1305–1307.

ABSTRACT

Since congenital cytomegalovirus (CMV) infection causes late-onset sequelae, the identification of CMV-infected newborns is important. For this purpose, we established a simple real-time PCR assay using a filter disk. Combined with the collection of urine using filter papers placed in the diaper, this assay can make CMV screening more feasible and cost-effective.

LINK TO THIS FREE ARTICLE

6 Barampouti F, Rajan M, Aclimandos W. Should active CMV retinitis in non-immunocompromised newborn babies be treated? Br J Ophthalmol. . 2002 Feb ;86(2):248–249.

LINK TO THIS FREE ARTICLE

7.Cannon MJ, Davis KF. Washing our hands of the congenital cytomegalovirus disease epidemic. BMC Public Health. . 2005 ;570.

ABSTRACT

...Given the present state of knowledge, women deserve to be informed about how they can reduce their risk of CMV infection during pregnancy, and trials are needed to identify effective educational interventions.

LINK TO THIS FREE ARTCLE

Edited July 24, 200817 yr by JACK