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. 2023 Mar 24;9(2):17.
doi: 10.3390/ijns9020017.

A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection

Chieko Hoki  1 , Michelle White  1 , Megan H Pesch  2 , Ann J Melvin  3 , Albert H Park  1
Affiliations

A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection

Chieko Hoki et al. Int J Neonatal Screen. .

Abstract

Congenital cytomegalovirus (cCMV) continues to be a major public health care issue due to its high prevalence throughout the world. However, there is a paucity of studies evaluating how providers manage this infection. This study surveyed North American Pediatric Infectious Disease (PID) physicians to elicit their approach towards the evaluation and treatment of this condition. Thirty-two PID physicians responded to this survey. Institutional testing and screening for cCMV were infrequently reported. The respondents in general agreed upon most laboratory and diagnostic testing except for neuroimaging. For those tests, there was a disparity in indications for head ultrasound versus brain MRI imaging. Most (68.8%) agreed with the clinical practice of starting valganciclovir in an infant less than 1 month of age with one sign or symptom of disease, and 62.5% would do so for an infant with isolated sensorineural hearing loss. However, only 28.1% would treat cCMV-infected infants older than 1 month of age. In conclusion, few healthcare institutions represented by PID physicians in this cohort had a cCMV screening or testing initiative, yet most respondents would test at a much higher level based on their clinical practice. While there is general consensus in evaluation and treatment of these children, there are disparities in practices regarding neuroimaging and indications for antiviral treatment with respect to age and severity of disease. There is a great need for an evidence based policy statement to standardize cCMV workup and treatment.

Keywords: CMV; congenital; cytomegalovirus; infection; infectious disease; newborn; screening; torch infection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Institutional or Personal Protocol for Early CMV testing/screening. NICU: neonatal intensive care unit; SNHL: sensorineural hearing loss; SGA: Small for gestational age; NBHS: newborn hearing screen. Other: HIV exposure or maternal immunodeficiency.
Figure 2
Figure 2
Recommended Workup for cCMV-diagnosed infant according to the PID respondents. Comprehensive metabolic profile (CMP): glucose, calcium, sodium, potassium, carbon dioxide, chloride, blood urea nitrogen, creatinine, albumin, protein, transaminases; other: abdominal ultrasound, CMV PCR blood titers and toxoplasmosis serology.
Figure 3
Figure 3
Indications for valganciclovir therapy in cCMV-infected infants.
See this image and copyright information in PMC

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