Authors (including presenting author) :
Chan WH(1), Li CM(2), Wong CME(2), Chu TC(2), Yim CL(3), Long C(4), Lee CYJ(4), Chan NM(1), Siu KL(1), Ho PPK(1), Yau YS(1), Wong SMY(1)
Affiliation :
(1)Department of Paediatrics, Queen Elizabeth Hospital, (2)Department of Ear, Nose & Throat, Queen Elizabeth Hospital, (3)Department of Ophthalmology, Hong Kong Children’s Hospital, (4)Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital
Introduction :
The prevalence of congenital cytomegalovirus (cCMV) infection has been reported as 0.2% to 2.0% of pregnancies. cCMV infection is the most common congenital infection and the major infectious disease cause of sensorineural hearing loss (SNHL) and neurodevelopmental abnormalities in infants in the world. It is suggested that effective antiviral therapy (ganciclovir/valganciclovir) started within 1-month-of-life for 6 months can improve these outcomes in these patients. Hence, various international recommendations suggested antiviral treatment, and serial hearing, ophthalmologic and neurodevelopmental surveillance for these patients.
Objectives :
1. Review the clinical outcomes of cCMV patients in the Department of Paediatrics, QEH from 2015 till 2024, 2. Assess feasibility of implementation of this multidisciplinary programme in other Hospital Authority (HA) Paediatric Centres.
Methodology :
Newborns diagnosed of cCMV infection were assessed by paediatricians and antiviral therapy were started within 1-month-of-life for symptomatic cCMV patients. These patients underwent thorough clinical assessment and serial monitoring on clinical, blood, ophthalmologic, neuroimaging and hearing surveillance to look for complications from antiviral therapy and cCMV infection.
Result & Outcome :
There are 24 patients diagnosed cCMV infection. Twenty-three of 24 patients are symptomatic and 1 is asymptomatic. Antiviral therapy had been started for all symptomatic patients and completed in 20 patients (86.9%). Three patients (13%) cannot complete therapy because of persistent neutropenia and or thrombocytopenia. None has retinal CMV involvement. Nineteen patients (79.2%) have no or mild neuroimaging abnormalities while 5 (20.8%) has moderate to severe abnormalities. Serial hearing surveillance for all cCMV patients with various methods according to age. There is 1 patient (4.2%) suffered from bilateral severe-profound SNHL required cochlear implants at the age of 2. Three patients (12.5%) developed progressive unilateral or bilateral severe-profound SNHL requiring unilateral or bilateral hearing aids. Five patients (20.8%) have mild to moderate, unilateral or bilateral SNHL and don’t need any form of hearing assistance. Fifteen patients (62.5%) have normal hearing. All patients referred for formal developmental assessment. Eight patients (33.3%) have global developmental delay, limited intelligence to mental disability or autism spectrum disorder. These patients were referred for early developmental training and interventions. Symptomatic cCMV infection may have life-long adverse hearing and cognitive outcomes. Management strategies include the above structured multi-disciplinary programme can improve patients’ outcomes. This is the first of it's kind programme in Paediatric centre in HA. It is suggested to implement this programme in other Paediatric centres in HA and it is feasible without utilization of too many extra resources.
