After the delivery:
It is highly important to perform these tests in the first two weeks of the newborn’s life. After this time, it would not be possible, for the most part, to determine with certainty whether the infection was intrauterine or an infection that occurred during or after the birth.
Saliva test-Performed in some hospitals and provides a reliable result only if negative, and it indicates that the fetus was not infected.
A positive result, which indicates infection, can also stem from passage through the birth canal and also as a result of breastfeeding, and therefore it is not conclusive.
In case of a positive result in the saliva test, make sure to also perform a urine test. The advantage of this test lies in the simplicity of sample collection.
Urine test – provides a reliable and final answer to the question whether the baby was infected during the pregnancy. The result is received a few days later. Unlike the saliva test, the collection of the urine sample from the newborn sometimes involves technical difficulties.
Results of tests:
Negative result – ends the case of CMV pregnancy and there is no more cause for concern due to the virus once it is done.
After the birth, the baby is the same as other babies, and his postnatal infection should not have a long-term effect.
Positive result – means that the baby was infected during the pregnancy.
If the urine test is positive, several tests need to be performed after the birth:
Blood tests – blood count and liver functions.
Brain ultrasound – performed by a radiologist specializing in children.
Eye fundus examination – performed by an ophthalmologist in order to exclude findings consistent with a congenital infection.
Bera hearing test (abr) – a hearing test that checks the brain stem’s reaction to sound stimuli. You can read more about the test further below.
The Bera / abr is a hearing test that checks the brain stem’s reaction to sound stimuli.
During the test, electrodes are attached to the baby’s head and a small earpiece is placed in the ear.
The test must be done during sleep, and therefore, until the baby can be independently put to sleep, the test will only be done during natural sleep. It is best to bring the baby to the test as tired as possible.
If the baby cannot be naturally put to sleep, a sleep inducing syrup will be used. The syrup is administered to the baby by a nurse who checks their vital signs, the child wakes up a few minutes after the test and needs to remain under parental observation at home on the day of the test.
It is important to note that the hearing screening test done to all newborns is not enough in case of suspected congenital CMV infection, and that is why the Bera/abr test is necessary as well.
The Ministry of Health recommends breastfeeding, and babies with CMV are no exception to this recommendation.
The baby’s infection with CMV after birth does not have a long-term effect such as the one possible with intrauterine infection, so that a mother who is infected with the virus does not need to be concerned about infecting the baby. On the contrary, as with any illness, it is better and advisable to breastfeed in order to pass on antibodies to the baby.
If the preterm baby is born with congenital CMV, the mother can breastfeed him with no restrictions, since he carries the antibodies from the time of the pregnancy and will not contract the virus due to breastfeeding.
If the preterm baby was not infected with the CMV virus during pregnancy, the recommendation is for maternal milk nutrition. However, it is known that small preterm babies can become infected with CMV from maternal milk and their condition might deteriorate due to the infection. These infections probably do not cause long-term damage, and therefore we try to reduce the quantity of the virus in the maternal milk by freezing the milk before feeding.
In any case, consult the preterm department staff before feeding, and it is recommended to consult an infectious diseases doctor specializing in the CMV virus
You can seek treatment with any pediatric CMV specialist, regardless of the hospital where the delivery took place.
The CMV virus requires specific knowledge. Since this is the most common congenital virus in Israel and worldwide, it is widely investigated, and the frequency of the discoveries – followed by changes to the monitoring and treatment protocol – are of significance, so the specialist’s daily engagement with the subject is of great importance.
Therefore, it is important to be monitored by an infectious diseases doctor who is an expert on the subject and no settle for a general pediatrics infectious diseases doctor.
You can find the contact details under the tab Important Telephone Numbers.
If a hearing impairment is discovered, even if this is an isolated impairment without any other sign of infection, with the recommendation of the infectious disease specialist, the baby will start drug treatment with a drug called Valganciclovir, proven to be very effective in stopping the deterioration in hearing and in certain cases even in improving the hearing that was impaired due to the virus.
In some cases, the brain ultrasound finds a finding called LSV. In the past, experts thought that the finding suggests possible future hearing impairment, and those babies would receive drug treatment in the aim of preventing hearing deterioration. Nowadays, even though LSV is found in a high rate of newborns due to improvement in imaging measures, but their follow-up did not indicate any increase in the prevalence of hearing impairment. Therefore, in most cases, these babies will not receive drug treatment.
The drug Valganciclovir, or under the brand name Valcyte, is an anti-viral drug that greatly reduces the amount of CMV viruses in the patient’s body. The reduction in the number of viruses diminishes the inflammatory process caused by the virus. The drug has been used from the 80s of the previous century. The drug has one known side effect in human beings: Decrease in the number of neutrophils white blood cells, which necessitates follow-up on blood counts and in the event of a decrease, the temporary discontinuation of the drug. Most significant side effects, such as impairment of male fertility, were described in lab animals, but not in human beings.
Some of the hospitals in Israel treat with Valganciclovir according to the treatment protocol by Prof. David Kimberlin from Birmingham University in Alabama, the global pioneer of CMV drug treatment, that dictates that the drug needs to be received twice a day for six months.
Other hospitals follow the treatment protocol constructed following the multiannual work of Prof. Jacob Amir, who was among the first in the world to extend treatment with the drug to the first year of the baby’s life, at a dosage of twice a day for the first three months and once a day for additional nine months.
Under the tab Protocols – Diagnosis, Treatment and Follow-Up you can read about the protocols that were given to us from the different hospitals
In order to receive the drug, you need to receive approval from the HMO through a process called 29c, performed directly with the HMO, after receiving instruction and after the attending infectious diseases doctor fills out the forms.
Most children, up to the age of 4, are carriers of many diseases and viruses, among which the CMV virus as well, which they constantly excrete through their bodily fluids. Pregnant women, and other at-risk populations always need to be careful about coming into contact with the bodily fluids and excretions of young children, and CMV is no exception.
You can see here the Rules for Preventing Infection.
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