# Symptomatic Congenital Cytomegalovirus Infection in a Preterm Very-Low-Birth-Weight Infant Treated With Intravenous Ganciclovir Followed by Oral Valganciclovir

## TL;DR

A preterm very-low-birth-weight infant with congenital CMV infection was successfully treated with intravenous ganciclovir followed by oral valganciclovir, showing improved outcomes.

## Contribution

This case study presents a viable treatment strategy for preterm VLBW infants with symptomatic congenital CMV using a combination of intravenous and oral antiviral therapy.

## Key findings

- Intravenous ganciclovir followed by oral valganciclovir led to a marked reduction in CMV-DNA levels in blood and urine.
- Platelet counts recovered, and auditory evaluation showed normal hearing in the treated infant.
- Antiviral therapy was administered safely in this high-risk population with appropriate monitoring.

## Abstract

Oral valganciclovir (VGCV) therapy has been shown to be effective against congenital cytomegalovirus (CMV) infection, with improvements in both auditory and neurological outcomes. However, therapeutic strategies remain undefined for cases involving preterm infants born before 34 weeks of gestation or those with a birth weight below 1200 g. We report a case of a male neonate born at 32 weeks and four days of gestation, with a birth weight of 1168 g, diagnosed with symptomatic congenital CMV infection. Diagnosis was based on positive CMV-DNA in urine and clinical findings, including ventriculomegaly and thrombocytopenia. Intravenous ganciclovir (GCV) was initiated, followed by a transition to oral VGCV. A marked reduction in CMV-DNA levels in both blood and urine was observed, along with recovery of platelet counts. Auditory evaluation revealed normal hearing. In severe cases of symptomatic congenital CMV infection in preterm very-low-birth-weight (VLBW) infants, initial intravenous GCV administration before oral VGCV may represent a viable treatment option. Furthermore, with appropriate monitoring for adverse events, antiviral therapy can be administered safely in this high-risk population.