Antiviral Treatment and Risk of Hearing Loss in Asymptomatic and Mild Symptomatic Infants with Congenital Cytomegalovirus

Read article: Submitted by: Dr Widad ALSalmiSydney Children’s Hospital at Randwick, NSWBackground:Asymptomatic congenital cytomegalovirus (AcCMV) is associated with delayed onset hearing loss (DOHL), reported at 10 – 15%, occurring within the first 2 – 6 years of life. Antiviral therapy to prevent DOHL for AcCMV children with no or mild symptoms (the most common scenario) is still unclear. This retrospective study of prospectively followed ‘mild AcCMV’ babies enrolled in the European Registry of Children with cCMV (cCMV net) assessed hearing outcomes at 24 months of age, and investigated the impact of antiviral treatment by comparing treated and untreated infants. Mild AcCMV was defined as babies with no hearing loss at birth, with normal physical and neurological examination, alanine aminotransferase <80 U/L, platelets >100,000 cs/mm3, with normal or minor radiological findings (cranial ultrasound (cUS) and/or brain MRI).Main Findings: One hundred and ninety six children of 1091 (18%) met criteria. 68/196 (34.7%) received antiviral treatment (valganciclovir/ganciclovir) and 128 (65.3%) not. Treated children were significantly of lower gestational age with lower growth parameters, and significantly more likely to have had cUS or MRI abnormalities. 9/196 (4.6 %) developed HL at 24 months. There was no statistical difference in HL between the treated group (3/68, 4.4%) vs non treated group (6/128, 4.7% ) (P = 0.658). There was no significant difference in being born to mothers with primary CMV infection or cranial US findings between children with HL and no HL. Limitations and strength: This a biased population from the European cCMV registry (8 countries, 57 hospitals) where children were identified because of ‘targeted’ testing (maternal antenatal CMV infection or clinical ‘flags’ in babies), thus limiting the interpretation (so, may not be applicable to all AcCMV babies), and only applicable till age 24 months. On the other hand, this is a relatively large cohort, prospectively followed, and from a wide range of European countries and institutions. Take home message: There appears to be no role for treating mild asymptomatic cCMV disease in babies identified as a result of ‘targeted testing’, even if there are mild clinical flags and mild abnormal neuroimaging findings. This recommendation is similar to the current Australian Society of Infectious Diseases (ASID) perinatal guidelines

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Quiz Questions

1.
1. What is the estimated overall rate of hearing loss (HL) in children with congenital cytomegalovirus (cCMV) infection?
- A.
  A) 9.9%
- B.
  B) 4.6%
- C.
  C) 12.6%
- D.
  D) 2.8%
2.
2. What is the overall risk of late onset hearing loss within 2 years of age in mild asymptomatic cCMv in this cohort, irrespective of treatment?
- A.
  A) 10%
- B.
  B) 20%
- C.
  C) <5%
- D.
  D) 8%
3.
3. What was the main finding regarding neuroimaging results and their association with DOHL risk in this study?
- A.
  A) Minor findings in neuroimaging were strongly associated with DOHL
- B.
  B) There was no clear association between mild neuroimaging findings and DOHL
- C.
  C) Major neuroimaging findings were not associated with DOHL
- D.
  D) Neuroimaging findings were not performed on the children in this study
4.
4. Which of the following is not a feature of mild cCMV as defined in this study?
- A.
  A) Jaundice, petechiae
- B.
  B) small for gestational age (SGA)
- C.
  C) Normal or minor findings in cUS/MRI
- D.
  D) Microcephaly

Quiz Outcomes

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Results