1. Mestas, Erin MSN, NNP-BC, CLC

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What is Cytomegalovirus?

Cytomegalovirus, or CMV, is a common virus that most adults have been infected with at some time in their life. It is most common in preschool- and school-aged children. CMV does not usually cause significant symptoms in healthy children or adults. But, if a woman gets CMV for the first time when she is pregnant, it can travel to her baby and cause significant symptoms. The baby is then born with congenital CMV.


How does a baby get CMV?

A baby can get CMV from his or her mom through the placenta, during the birth process, or from CMV-infected breast milk. CMV that is contracted by a baby during pregnancy is typically the most concerning and is referred to as congenital CMV.


What does congenital CMV do to a baby?

If a baby gets CMV early in the pregnancy, CMV can cause abnormalities in a baby's development, especially his or her brain, ears, and eyes. If they get it later in the pregnancy, their development might not be as impacted. Babies born with congenital CMV may have abnormal values in their blood work (low platelets), may be small for their age, and may fail their newborn hearing screen. The medical team caring for these babies will do a thorough assessment and examination to determine how and what has been impacted (Figures 1 and 2).

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Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

How will you know if my baby has congenital CMV?

Congenital CMV is sometimes first suspected before a baby is born. This may be based on abnormal ultrasounds or slower than normal growth of the baby. If congenital CMV is suspected before a baby is born, testing can be done on the mom's blood or on the baby's amniotic fluid to look for the virus or exposure to the virus.


If congenital CMV is not suspected until after a baby is born, there are tests that can be done to look for the virus' DNA. The virus is present in the blood and urine of babies with CMV. If there is concern for congenital CMV, your baby's urine or blood can be sent to a laboratory. If they find CMV in your baby's blood or urine, an additional test may be done to see how much of the virus is in your baby's blood or urine. This helps your medical team know how to treat your baby.


How is congenital CMV treated?

Congenital CMV is treated with a medication called ganciclovir. This can be given only in a special intravenous catheter called a central line. Your baby's medical team will talk to you about this. Ganciclovir is usually given every 12 hours for 3 to 6 weeks. At the end of the treatment, your baby's medical team will talk with you about the next steps. Often treatment may then continue with a medicine given by mouth for several weeks or months.


If your baby is diagnosed with congenital CMV, your medical team will talk to you about additional tests that they will need to do in order to see how CMV has impacted your baby. Additional tests may include:


* A cranial ultrasound


* Magnetic resonance imaging of your baby's brain


* Eye examinations by a pediatric ophthalmologist


* Newborn hearing screen and further hearing assessment


* Blood work to look at blood cell counts and liver function


* Close examination and follow-up with occupational and physical therapy


* Speech therapy


What are the risks with ganciclovir?

Ganciclovir can cause some abnormalities in your baby's blood cell count. These abnormalities are temporary and will go away once the ganciclovir is stopped. We will check your baby's bloodwork often to see how much of the virus is left and to follow your baby's blood cell counts.


Ganciclovir may be harmful to those who are not being treated so it is important that anyone in contact with the medicine or your baby's urine or bodily fluids wear special gloves and a special gown.


Will ganciclovir reverse damage to my baby's brain or eyes?

Ganciclovir will not reverse damage that has already occurred, but it may help slow or prevent further damage from CMV. It can slow or reverse hearing loss, improve weight gain and head growth, and can reverse liver function abnormalities.


What else should I know about treating congenital CMV?

One of the most important things to know, when a baby is born with congenital CMV, is that it is very important the baby is cared for by a team of experts. Those experts should include people to care for and assess any complications your baby has from CMV. Your baby will continue to be cared for by a team of medical professionals after he or she leaves the hospital. It will be important to keep all of your appointments and to have a good relationship with your baby's primary care provider. The team caring for your baby in the NICU will help get your baby's outpatient care started.


If CMV can be transmitted in breast milk, should my baby still get my breast milk?

If your baby was born with congenital CMV, he or she has already been infected with the virus. In that case, your baby should still receive your breast milk. In fact, all of the important immune factors in your breast milk will help!


If your baby was not born with congenital CMV, the medical team caring for your baby will make a decision about how to handle your breast milk. They may choose to offer your baby your fresh breast milk or they may choose to freeze it first or pasteurize it first. These decisions are often made on a case-by-case basis and your NICU team will discuss this with you.