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Do Antivirals Improve Hearing Outcomes in Neonates With Congenital Cytomegalovirus Infection?

BACKGROUND Cytomegalovirus (CMV) is the leading nongenetic cause of congenital sensorineural hearing loss (SNHL), affecting approximately one-third of children with SNHL. Congenital CMV (cCMV)-associated SNHL can occur unilaterally or bilaterally, range from mild to profound, and is often progressive. The gold standard for the diagnosis of congenital CMV is detection on viral culture or polymerase chain reaction (PCR) using blood, urine, saliva, or cerebrospinal fluid within the first 21 days of life. PCR on dried neonatal blood spot has also emerged as a retrospective method of testing for congenital CMV infection in children without active viremia, although the sensitivity is poor. cCMV infection is classified as asymptomatic, asymptomatic with isolated SNHL, mildly symptomatic, and moderately to severely symptomatic. Mildly symptomatic cCMV is defined as the presence of one or two symptoms that are mild and transient. Moderately to severely symptomatic cCMV occurs when there are multiple manifestations of the infection along with central nervous system involvement. The recommended treatment of neonates with moderate to severe symptomatic cCMV is a 6-month course of oral valganciclovir. The treatment of SNHL in the setting of cCMV, however, is not well established.