- Design
- Single-arm systematic review and meta-analysis
- Population
- 8 studies, 192 infants with congenital CMV treated after the neonatal period
- Primary outcome
- Hearing outcomes and viral load
- Effect
- Hearing normalised in 42% of affected ears (95% CI 13–78%), improved in 38%; deteriorated in 5%
This meta-analysis pooled eight studies of 192 infants with congenital cytomegalovirus who started valganciclovir or ganciclovir after the first month of life, often because the infection was recognised late.
Urine and plasma viral loads fell over the first two months. Among ears with hearing loss, about 42% returned to normal and about 38% improved, while about 5% deteriorated. Grade 3–4 neutropenia occurred in about 4%.
The studies had no untreated comparison groups, and heterogeneity was very high (I² over 80% for the hearing outcomes). Some hearing loss in congenital CMV fluctuates or improves on its own, so these figures cannot show how much treatment added. Guidelines currently support treatment started in the neonatal period for symptomatic infants; this review does not establish late treatment as standard, but it gives families and clinicians something to discuss when the diagnosis is made after the first month. It was published in September 2026.
- Discuss late antiviral treatment case by case with paediatric infectious diseases when congenital CMV is diagnosed after the first month.
- Monitor neutrophil counts on valganciclovir.
- Keep audiological follow-up regular, since CMV-related hearing loss can fluctuate or progress.
- Aim to diagnose congenital CMV in the newborn period, when the evidence for treatment is strongest.
Why it matters
Many congenital CMV infections are recognised after the neonatal window, and families ask whether treatment is still worthwhile.
Don't overread it
Without untreated comparison groups, hearing improvement cannot be attributed to the drug.
The statistics, in plain English
A single-arm meta-analysis pools outcomes in treated patients only, so it cannot compare with no treatment. An I² above 80% means the studies disagreed a lot, and the confidence interval for normalisation (13%–78%) is very wide.
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