A neonate born at 36 weeks has petechiae, hepatosplenomegaly, jaundice, and chorioretinitis at birth. TORCH workup reveals IgM positive and IgG positive for CMV, and urine CMV-PCR is positive. The treatment of choice to prevent long-term sensorineural hearing loss in this symptomatic congenital CMV case is:
- A Oral valganciclovir 16 mg/kg/dose twice daily for 6 months ✓
- B IV ganciclovir 6 mg/kg/dose twice daily for 6 weeks
- C CMV-specific immunoglobulin therapy
- D Foscarnet IV for 14 days followed by maintenance
Correct answer: A. Oral valganciclovir 16 mg/kg/dose twice daily for 6 months
Explanation
Current evidence (National Institute of Allergy and Infectious Diseases trial) supports oral valganciclovir 16 mg/kg/dose twice daily for 6 months for symptomatic congenital CMV with CNS involvement to prevent or limit progressive sensorineural hearing loss and improve neurodevelopmental outcomes. The 6-month regimen was shown superior to 6-week IV ganciclovir. Valganciclovir achieves equivalent plasma ganciclovir levels with oral dosing. CMV immunoglobulin has no established role in post-natal treatment of congenital CMV. Foscarnet is reserved for ganciclovir-resistant cases.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.