Explaining congenital CMV, valganciclovir and hearing surveillance — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the neonatal unit. A 10-day-old term baby has been admitted with prolonged jaundice, petechiae, an enlarged liver and spleen, a platelet count of 45 × 10⁹/L, and a referred newborn hearing screen on the left. The cranial ultrasound shows periventricular calcifications. Congenital cytomegalovirus is the working diagnosis. ^[10]

Your tasks are: ^[9]

1. Explain the diagnosis of congenital cytomegalovirus in plain language — what the virus is, how the baby acquired it, and what the findings mean. ^[10]
2. Explain why a saliva PCR must be done now, within the first 21 days of life, and what it will tell you. ^[11]
3. Explain the treatment decision — valganciclovir for six months — what it aims to achieve and what monitoring it requires. ^[8]
4. Explain the long-term hearing surveillance, including why a baby who passed one ear still needs audiology into school age. ^[13]
5. Address the mother's question about preventing CMV in a future pregnancy. ^[9]

You are not expected to commit to a prognosis beyond what the evidence supports, or to prescribe without senior review — flag that the final treatment plan will be confirmed by the consultant. ^[9]