It is routine practice in our newborn nursery (and many others) to look for evidence of cytomegalovirus (CMV) infection in infants who fail their newborn hearing screen, as congenital CMV (cCMV) infection is the leading non-genetic cause of sensorineural hearing loss.
If the test comes back positive, should you start antiviral medication to prevent or minimize hearing loss?
This week, Pediatrics is early releasing a Pediatrics Perspectives by Tatiana Lanzieri MD, Megan Pesch MD, and Scott Grosse PhD from the CDC and the University of Michigan, entitled “Considering Antiviral Treatment to Preserve Hearing in Congenital CMV” (10.1542/peds.2022-059895).
Bottom line – it’s not an easy question to answer. The authors thoughtfully lay out the existing evidence for and against antiviral treatment, and I urge you to read the details of their arguments. The evidence that supports preservation of hearing with antiviral use exists, but in most studies, sample sizes are small, and follow-up data are limited, so it is unclear whether the benefit of antiviral use is long-lasting.
Additionally – and importantly, nearly one-third of infants will experience neutropenia or other adverse events, which necessitates frequent blood sampling for the 6-month treatment duration.
The authors conclude by emphasizing the importance of shared decision-making when it comes to antiviral treatment for these infants. Finally, we should remember that antiviral treatment is just one option and that, regardless of the decision, these infants will need a coordinated clinical management plan, which includes clinical and developmental monitoring, early intervention therapies, and support of the family.