A neonate fails hearing screening and urine PCR taken at 10 days is positive for CMV. Auditory brainstem responses show unilateral severe sensorineural loss; examination is otherwise normal. What is the best next step?
The time-stamped PCR establishes congenital infection; management integrates systemic assessment, antiviral eligibility and longitudinal auditory development rather than a one-off screen.
A. Arrange audiology alone and omit systemic assessment because the loss is unilateral: Congenital CMV may have systemic manifestations and the opposite ear remains at risk of delayed loss.
B. Start valganciclovir immediately without baseline blood counts, liver tests or paediatric review: Antiviral benefit and toxicity require time-sensitive specialist selection and laboratory monitoring.
C. Base rehabilitation on this single ABR and discharge after fitting: Thresholds can fluctuate or progress, so serial frequency-specific assessment and developmental monitoring are required.
D. Delay habilitation until antiviral treatment is complete: Communication access should be addressed promptly and in parallel with medical assessment.
E. Urgent multidisciplinary congenital-CMV assessment, serial audiology and time-sensitive antiviral discussion: Early confirmation permits evaluation for symptomatic disease, shared antiviral decisions and prompt hearing habilitation while monitoring the other ear.
If CMV testing first became positive after 21 days without a stored newborn sample, congenital and postnatal infection could not be reliably distinguished.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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