Abstract:
Background: Human cytomegalovirus (CMV) is the most common cause of viral infection acquired in utero. Newborns can be symptomatic or asymptomatic at birth. The most frequent clinical signs are hepatosplenomegaly, severe thrombocytopenia, enterocolitis, intestinal bleeding, neurological abnormalities: severe encephaloclastic injury, intracerebral calcifications (striatal angiopathy), cystic periventricular leukomalacia, sensorineural hearing loss. Materials/methods: In our department, Neonatal Department of Speranskiy Children Hospital, during the period from the beginning of 2015 to the end of 2017 we screened for CMV about two thousands infants under 3 months. We used quantitative polymerase chain reaction diagnostics to reveal cytomegalovirus in blood samples as a screening method. It helped to identify the asymptomatic patients who needed a treatment due to the high viral load. Blood biochemistry and complete blood count were performed to check for side effects and viral activity, as well as acoustic tests to assess the patient’s hearing. Brain ultrasound and MRI were performed to estimate brain damage. Results: During three years we observed 91 CMV positive infants under 3 months old (including 38 under 1 month); 28 of them were preterm. Eight newborns had severe congenital CMV infection with hepatosplenomegaly (all 8 babies), severe thrombocytopenia (5), bleeding and petechiae (all 8), enterocolitis (4), encephaloclastic injury (4). The convention in our department is to use intravenous (IV) immunoglobulin and IV ganciclovir for 2-4 weeks and then, if oral intake is possible, to switch to oral valganciclovir for a longer period (six weeks and longer). All the treated children had significant clinical improvement with only residual neurological defects (2) and no hearing loss was registered. Conclusions: In case of severe congenital cytomegalovirus infection there should be a complex therapy. In our department 8 newborns with severe congenital CMV treated with IV immunoglobulin, IV ganciclovir and oral valganciclovir had significant clinical improvement with only residual neurological defects and no deafness. In case of severe congenital cytomegalovirus infection we recommend a complex therapy including specific intravenous immunoglobulin and intravenous ganciclovir and oral valganciclovir (6 weeks and longer).
