Meine Jansen Caroline F, Toet Mona C, Rademaker Carin M A, Ververs Tessa F F, Gerards Leo J, van Loon Anton M
Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Netherlands.
J Perinat Med. 2005;33(4):364-6. doi: 10.1515/JPM.2005.065.
Cytomegalovirus (CMV) is the most common cause of congenital infection in humans. Some congenitally infected infants will develop sequelae later in life, especially sensorineural hearing loss (SNHL) and mental retardation. There is no generally accepted antiviral therapy for the treatment of symptomatic congenital CMV infections yet. We present a neonate with symptomatic congenital CMV infection, who was treated with intravenous (iv) ganciclovir (GCV) during 18 days and subsequently with oral valganciclovir (VGCV) for 5.5 months, in an attempt to prevent development of SNHL. GCV was given intravenously 10 mg/kg/day in two doses and VGCV doses ranged from 280-850 mg/m2 bidaily (bid). Our experience shows that it is not possible to give a fixed dosing regime for VGCV in neonates and that continuous adaptation of dose is necessary to achieve stable target levels of GCV and to keep the viral load in urine at undetectable level. At 18 months of age no hearing deterioration has occurred. While the current findings are encouraging, the limitations of a single case report with a relatively short follow-up emphasizes the need for further prospective randomized studies to evaluate pharmacokinetics, efficacy and safety of VGCV therapy in neonates with congenital CMV infection.
巨细胞病毒（CMV）是人类先天性感染最常见的病因。一些先天性感染的婴儿在日后生活中会出现后遗症，尤其是感音神经性听力损失（SNHL）和智力发育迟缓。目前尚无普遍接受的抗病毒疗法用于治疗有症状的先天性CMV感染。我们报告一例有症状的先天性CMV感染新生儿，其接受了18天的静脉注射更昔洛韦（GCV）治疗，随后口服缬更昔洛韦（VGCV）5.5个月，以试图预防SNHL的发生。GCV静脉注射剂量为10mg/kg/天，分两次给药，VGCV剂量为280 - 850mg/m²，每日两次（bid）。我们的经验表明，不可能为新生儿制定固定的VGCV给药方案，必须持续调整剂量以达到稳定的GCV目标水平，并使尿病毒载量维持在不可检测水平。该患儿18个月时未出现听力恶化。尽管目前的结果令人鼓舞，但单病例报告且随访时间相对较短的局限性强调了需要进一步进行前瞻性随机研究，以评估VGCV疗法在先天性CMV感染新生儿中的药代动力学、疗效和安全性。
