LAUSR

Z et al in their article emphasize the hematologic adverse effects among infants with congenital cytomegalovirus infection treated with valganciclovir. We have cared over 12 years for 156 infants with congenital cytomegalovirus infection. Nineteen of them (12.2%) were treated with antiviral therapy (6 ganciclovir/6 weeks, 9 valganciclovir/6 weeks, 4 valganciclovir/6 months) starting at a median age of 6 days (interquartile range: 2–21). Compared with Ziv et al, who had 28.8% of infants with any grade (Grade 1–4, according to National Institute of Allergy and Infectious Diseases division of AIDS Toxicity Tables, 2004) of neutropenia during the treatment, 52.6% (2/6 on ganciclovir, 8/13 on valganciclovir) of our patients had at least one episode of such adverse effect, 80% of whom had more than one episode (32 episodes of neutropenia overall). Interestingly, according to reference ranges for neutrophils count by Schmutz et al, 100% of our patients were neutropenic. In our population, 88.8% of episodes occurred in the first 3 weeks of treatment. In Ziv’s population, 5.6% of infants had Grade 3–4 neutropenia, versus 26.3% (2/6 on ganciclovir, 3/13 on valganciclovir) of our patients, who had it mostly (80%) in the first 3 weeks of treatment. The drug was temporarily suspended in 40% of infants with Grade 3–4 neutropenia. Granulocyte colony-stimulating factor was administered to 3 infants. One neonate had a sepsis caused by Klebsiella pneumoniae, with a full recovery, during a Grade 4 neutropenia episode. There are limited data in the literature about bone marrow toxicity caused by ganciclovir/valganciclovir in infants. Kimberlin et al reported Grade 3–4 neutropenia in 63% of infants treated with ganciclovir, 13.8% of whom had the drug permanently discontinued, while in the remaining the dosage was reduced. In 2015, Kimberlin