Multidisciplinary Management of an Preterm Infant with CMV Infection : A Case Report

Apstract This case report presents the complex clinical course of a female preterm neonate born at 31 + 4 weeks of gestation, with low birth weight (970g) and reduced Apgar scores (6/5/5). The infant was hospitalized for 119 days in the neonatal intensive care unit (NICU), where she underwent extensive diagnostic evaluations and multidisciplinary treatment. Laboratory testing confirmed CMV DNA positivity in both blood and cerebrospinal fluid (CSF), indicating active congenital infection. Neuroimaging revealed periventricular leukomalacia (PVL) and hydrocephalus, which were managed through serial lumbar punctures and close neurological monitoring. Persistent thrombocytopenia prompted hematology consultation, while elevated direct bilirubin levels led to gastroenterology. Pediatric cardiology evaluation identified a left-to-right shunt at the foramen ovale and incomplete interventricular septal continuity. Ophthalmologic assessment revealed aggressive posterior retinopathy of prematurity (AP-ROP), treated with intravitreal anti-VEGF injection and followed closely due to post-injection hemorrhages. Additional investigations included TORCH screening, immunological testing, brain MRI, and auditory and visual assessments. The multidisciplinary team included neonatologists, neurosurgeons, hematologists, gastroenterologists, cardiologists, and ophthalmologists. Treatment involved antiviral and antibiotic regimens, supportive care, and structured follow-up for neurodevelopment, hearing, and vision. This case highlights the importance of early diagnosis and coordinated multidisciplinary management in congenital CMV infection, particularly in preterm infants with neurological, hematological, hepatobiliary, cardiac, and ophthalmologic complications. It underscores the value of integrated clinical protocols and long-term follow-up to improve prognosis and reduce morbidity in this vulnerable patient population.. It also highlights the need for heightened clinical vigilance and collaborative care to mitigate long-term morbidity and optimize neurodevelopmental outcomes.