A neonate born at 36 weeks is noted to have bilateral sensorineural hearing loss, chorioretinitis, periventricular calcifications on cranial ultrasound, and hepatosplenomegaly at birth. The TORCH screen shows positive IgM for CMV. Which is the MOST appropriate treatment?
- A IV ganciclovir 6 mg/kg/dose every 12 hours for 6 weeks
- B No treatment; supportive care only
- C Oral valganciclovir 16 mg/kg/dose every 12 hours for 6 months ✓
- D IV foscarnet for 3 weeks
Correct answer: C. Oral valganciclovir 16 mg/kg/dose every 12 hours for 6 months
Explanation
Congenital CMV with symptomatic disease (hearing loss, chorioretinitis, CNS involvement) warrants antiviral therapy. Current evidence (CASG 109 trial) supports oral valganciclovir 16 mg/kg/dose twice daily for 6 months as the standard of care, which improves hearing and neurodevelopmental outcomes better than 6-week IV ganciclovir. IV ganciclovir is reserved when oral is not feasible. Foscarnet is used for ganciclovir-resistant CMV. Supportive care alone is inadequate for symptomatic congenital CMV.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.