Treatment of Congenital Cytomegalovirus Beyond the Neonatal Period: A Single-Arm Meta-Analysis.

OBJECTIVE: To evaluate hearing outcomes in postneonatal treatment of congenital cytomegalovirus (cCMV) infection and assess the effect of treatment initiated after the first month of life. DATA SOURCES: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. REVIEW METHODS: Articles reporting antiviral treatment of cCMV, with Ganciclovir (GCV) or Valganciclovir (VGCV) in the postneonatal period were included. Outcomes of interest included viral load (urine and plasma), neutropenia, and hearing outcomes (return to normal hearing, improvement, deterioration, and no change). Mean difference (MD) was used for continuous outcomes and proportions for binary endpoints, with 95% confidence intervals (CI). RESULTS: Eight studies with 192 patients met inclusion criteria. Oral VGCV was associated with a reduction in viral load during the first 2 months. At 2 months, pooled MD for urine viral load was -3.67 (95% CI -4.33 to -3.02, I2 = 75.4%), and for plasma was -0.80 (95% CI -1.08 to -0.52, I2 = 31.6%). Among patients with hearing loss, normalization occurred in 42.29% (95% CI 13.48 to 77.51, I2 = 84.3%) and improvement in 38.48% (95% CI 16.77 to 66.00, I2 = 88.2%) of total ears. Hearing deterioration was uncommon, affecting 5.47% of total ears (95% CI 2.15 to 13.25, I2 = 60.9%). Neutropenia was infrequent, with 9.09% experiencing grade 1-2 and 3.67% grade 3-4. CONCLUSION: Postneonatal antiviral treatment for cCMV may reduce viral load and improve hearing in a substantial proportion of patients, with low rates of adverse events. However, long-term outcomes remain unclear, and larger prospective studies are needed to confirm efficacy. LEVEL OF EVIDENCE: N/A.