Department of Pediatric Infectious Diseases and Immunology, Connecticut Children's Hospital, Hartford, Connecticut.
Department of Pediatrics, University of Connecticut, Farmington, Connecticut.
Curr Opin Pediatr. 2024 Aug 1;36(4):480-488. doi: 10.1097/MOP.0000000000001364. Epub 2024 May 14.
Universal and targeted screening of newborns for congenital cytomegalovirus (CMV) infection is increasing globally. Questions remain concerning the management of infants who have been identified with congenital CMV infection, especially those with "minimally symptomatic" or clinically inapparent infection. Our objective is to discuss current management of CMV-infected neonates with a focus on less affected infants with or without sensorineural hearing loss (SNHL).
Valganciclovir is being prescribed increasingly in neonates with congenital CMV infection for improvement in hearing outcomes through 2 years of age. Treatment initiated in the first month of age is recommended for clinically apparent disease. A recent study showed hearing improvement at 18-22 months of age when therapy was initiated at age 1-3 months in infants with clinically inapparent CMV infection and isolated SNHL.
Antiviral therapy with either ganciclovir or valganciclovir has shown moderate benefit in prevention of hearing deterioration among infants with clinically apparent CMV infection or isolated SNHL. Sustainability of benefit beyond 2 years of age remains unknown. At present, infants with clinically inapparent CMV infection (normal complete evaluation including hearing) should not receive antiviral therapy. All CMV-infected infants require close audiological and neurodevelopmental follow-up.
先天性巨细胞病毒（cytomegalovirus，CMV）感染的新生儿普遍筛查和靶向筛查在全球范围内不断增加。对于已确诊为先天性 CMV 感染的婴儿，特别是那些有“症状轻微”或临床无症状感染的婴儿，其管理仍存在疑问。我们的目的是讨论 CMV 感染新生儿的当前管理方法，重点是讨论有无感觉神经性听力损失（sensorineural hearing loss，SNHL）的受影响较小的婴儿。
更昔洛韦在先天性 CMV 感染的新生儿中越来越多地被用于改善听力结局，直至 2 岁。建议对有临床症状的疾病在出生后 1 个月内开始治疗。最近的一项研究表明，对于有临床无症状 CMV 感染和孤立性 SNHL 的婴儿，如果在 1 至 3 个月龄时开始治疗，其在 18 至 22 月龄时听力有改善。
更昔洛韦或缬更昔洛韦的抗病毒治疗在预防有临床症状的 CMV 感染或孤立性 SNHL 的婴儿听力恶化方面显示出一定的益处。其在 2 岁以上的益处的可持续性尚不清楚。目前，对于有临床无症状 CMV 感染（包括听力正常的完整评估）的婴儿不应进行抗病毒治疗。所有 CMV 感染的婴儿均需要密切的听力和神经发育随访。
