Key result
Antiviral treatment with ganciclovir and/or valganciclovir for postnatal CMV infection in extremely premature infants did not significantly improve mortality, length of stay, or neurodevelopment.
Why the study?
The impact and outcomes of postnatal cytomegalovirus (CMV) infection were not entirely clear, prompting an investigation into associations between postnatal CMV infection outcomes and antiviral treatment.
Does antiviral treatment with ganciclovir and/or valganciclovir improve clinical and developmental outcomes in extremely premature infants with postnatal CMV infection?
Cohort (n=103)
No
Does antiviral treatment with ganciclovir and/or valganciclovir improve clinical and developmental outcomes in extremely premature infants with postnatal CMV infection?
Effect estimate: OR 0.6 (95% CI 0.06-6.09)
Absolute Event Rate: 3.7% vs 6%
p-value: p=0.668
Antiviral treatment for postnatal CMV infection in extremely premature infants does not appear to significantly improve long-term neurodevelopmental or clinical outcomes.
Antiviral therapy should not yet alter management of postnatal CMV in extremely premature infants; leaves open need for randomized evidence.
BACKGROUND: The impact and outcomes of postnatal cytomegalovirus (CMV) infection are not entirely clear. We aimed to determine the associations between treatment outcomes of postnatal CMV infection and its antiviral treatment. METHODS: Retrospective study in a tertiary center. Infants of < 29 weeks gestational age who were tested for postnatal CMV infection were included. CMV-infected infants were compared to uninfected infants (control group). CMV-infected infants were either treated with ganciclovir and/or valganciclovir (CMVPT group) or not (CMVPNT group). Demographic, clinical, laboratory, treatment, and outcome data were collected. Primary outcomes were the length of stay, death before discharge and hearing impairment, cognitive and motor development as assessed by the Denver Developmental Screening Test II, and neurologic impairment at the corrected age of 1.5-2 years. RESULTS: We included 103 extremely premature infants. The Median (interquartile range [IQR]) length of stay was 94 (69-112) days in control, 85 (70-102) days in CMVPNT, and 100 (88-137) days in the CMVPT group. Mortality before discharge was 6% in control, 3.8% in CMVPNT, and 3.7% in the CMVPT group. Normal hearing at follow-up was found in 30/37 infants in control (81.1%), 13/13 infants in CMVPNT (100%), and 17/20 infants in the CMVPT group (85%). Denver Developmental Screening Test II results did not differ among the three groups. Neurologic impairment was found in 21/37 infants (56.8%) in control, 9/13 infants in CMVPNT (69.2%), and 14/20 infants in CMVPT group (70%). CONCLUSIONS: The associations between antiviral treatment of postnatal CMV infection and better treatment outcomes were nonsignificant.
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Košiček et al. (2022) conducted a cohort in Postnatal cytomegalovirus (CMV) infection (n=103). Ganciclovir and/or valganciclovir vs. No antiviral treatment (CMVPNT) and CMV-negative infants (control) was evaluated on Death before discharge (OR 0.6, 95% CI 0.06-6.09, p=0.668). Antiviral treatment with ganciclovir and/or valganciclovir for postnatal CMV infection in extremely premature infants did not significantly improve mortality, length of stay, or neurodevelopment.
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