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Treatment of Congenital Cytomegalovirus and Ganciclovir Therapeutic Drug Monitoring in Twin Preterm Infants

Congenitally acquired cytomegalovirus (CMV) infection is the most prevalent congenital infection worldwide and the most frequent cause of acquired sensorineural hearing loss. The burden of the disease is even more important in premature and very low birth weight infants. However, few data exist on the treatment with intravenous ganciclovir and oral valganciclovir in this vulnerable population. We report the case of twins congenitally infected with CMV and born prematurely at 27 weeks' gestation. Treatment regimens were initially individualized for their prematurity and renal function, and then adjusted with therapeutic drug monitoring (TDM) to adapt to their continuously evolving physiologic maturation. As infants were aging, the plasmatic half-life of ganciclovir slowly decreased to term infant values around 10 weeks of chronological age, or 37 weeks of postmenstrual age. Results for blood polymerase chain reaction tests became negative and long-term follow-ups were satisfactory in both twins. The limited data for infants born before 32 weeks of gestation or at less than 1200 g and evolution of ganciclovir pharmacokinetic parameters justify the use of TDM in these settings.

 

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The case report describes the treatment of twins with congenital CMV infection who were born prematurely at 27 weeks of gestation. The authors report that there are few data on the treatment of CMV in this vulnerable population, and that treatment regimens were individualized based on the infants' prematurity and renal function.

The infants were treated with intravenous ganciclovir and oral valganciclovir, and the doses were adjusted using therapeutic drug monitoring (TDM) to adapt to their evolving physiologic maturation. The authors note that the plasmatic half-life of ganciclovir slowly decreased as the infants aged, and that the blood polymerase chain reaction tests became negative over time. Long-term follow-up was satisfactory for both twins.

The authors suggest that the limited data on infants born before 32 weeks of gestation or at less than 1200 g, as well as the evolution of ganciclovir pharmacokinetic parameters, justify the use of TDM in these settings. This case report highlights the importance of individualized treatment and close monitoring in the care of premature infants with congenital CMV infection.

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