Referral and surveillance guidance if congenital cytomegalovirus (CMV)

Surveillance and Referral 1 month to one year

• Disease growth, developmental surveillance
  • monitor growth trajectories
    • including trends in head circumference (recovery from or persistence of microcephaly)
  • routine developmental screening at well visits
• Referrals and other considerations
  • paediatric ophthalmology (annually through age 5 for symptomatic infants)
  • monitoring by audiology (every 3-6 months until age 3, annually until age 6)
  • follow-up with a paediatric infectious disease specialist (until 24 months)
  • refer to a specialist for developmental assessment at 12 months in infants treated with valganciclovir
  • referral to early intervention services if available (1)

Surveillance and Referral 1 year to 6 years

• Disease growth, developmental surveillance
  • monitor growth trajectories
    • including trends in head circumference
  • routine developmental screening at well visits, including autism screening
• Referrals and other considerations
  • monitoring by paediatric ophthalmology (annual through age 5 for symptomatic)
  • monitoring by audiology (every six months)
  • follow-up with a paediatric infectious disease specialist (until 24 months)
  • consider vestibular testing and physical therapy if balance concerns arise Refer to a specialist for developmental assessment at 24 months in infants treated with valganciclovir
  • involvement with early intervention services if available (1)
  • transition to special education supports as needed (1)

Surveillance and Referral 6 years to 18 years

• Disease growth, developmental surveillance
  • monitor growth trajectories
    • including trends in head circumference as needed
  • routine developmental screening at well visits, including autism screening (1)
• Referrals and other considerations
  • vision and hearing monitoring as needed
  • consider neuropsychological testing for cognitive concerns (1)
  • special education supports as needed (1)
  • vestibular testing and physical therapy if balance concerns arise (1)
  • slowly increase the child's autonomy over their own medical needs (eg, daily hearing aid care, or stretches) as appropriate (1)

Reference:

1. Pesch MH et al. Congenital cytomegalovirus infection.BMJ 2021;373:n1212 | doi: 10.1136/bmj.n1212