PY Chow, KN Yuen, Leung, CS Ho

C.S. was born at 26 weeks gestation weighing 0.88kg. The antenatal course was uneventful but there was PROM for 7 days prior to delivery. He was ventilated after delivery and 2 doses of artificial surfactant were given. Ampicillin and Aztreonam were started after sepsis work-up. Initial CXR showed grade 3 RDS pattern but progressed to bilateral reticulonodular appearance on Day 2. Cloxacillin was added to cover possible staphylococcal interstitial pneumonia. He developed hepatosplenomegaly and thrombocytopenia. Urine Deaff test for CMV was found to be positive. Sputum grew candida spp and antifungal drugs were added with little response. He developed severe bronchopulmonary dysplasia and was ventilator dependent. A 5 weeks course of steroid together with diuretics and bronchodilators were given and repeated urine and sputum Deaff test for CMV were positive. On D67 after obtaining consent from parents, a 14 days' course of Ganciclovir was given at a dose of 10 mg/kg/D. The baby had dramatic improvement, was extubated successfully and eventually no oxygen supplement was required. Urine & sputum Deaff test for CMV became negative and child started to gain weight satisfactory. He had persistent neutropenia and investigations including marrow biopsy were all negative. The baby deteriorated again on D163 with positive sputum Deaff test and eventually succumbed because of pneumonia and cor pulmonale.

Ganciclovir is a synthetic analogue of guanine which inhibits replication of herpes viruses and has been found to be effective in the treatment of CMV infection in neonates. Side-effects such as blood dyscrasia can occur. The duration of treatment however remains uncertain and its use of neonatal viral infection should be further investigated.