Isolate in a single room in SCID treatment center; prohibit ill contacts.
Diagnose and treat any clinical abnormalities such as respiratory distress or signs of infectious or autoimmune conditions.
Introduce social worker to help with support and services for family.
Omit live vaccines for patient or household contacts including rotavirus vaccine
Avoid infection:
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Advise mother to suspend nursing while evaluating her prior exposure by CMV IgG serology.
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If mother CMV seronegative, encourage to resume nursing.
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If mother CMV seropositive and baby CMV negative by blood and urine PCR, advise mother to avoid nursing, given risk of breast milk transmission of CMV.
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Obtain infant blood CMV PCR weekly for 4 weeks and periodically thereafter (more often if CMV clinically suspected, such as with elevation of liver transaminases).
Intravenous access needed for gammaglobulin replacement with coordination of blood draws to decrease frequency of venipuncture. Establish more permanent intravenous access just prior to eventual hematopoietic cell transplant (HCT).
Provide nutritional support, including monitoring for iron deficiency.
Transfuse if symptomatic or hemoglobin <8 mg/dL, using only CMV-negative, leukoreduced, irradiated packed red cells.
Administer immunoglobulin to maintain IgG >800 mg/dL [37]
Administer palivizumab during respiratory syncytial virus season.
Begin prophylactic fluconazole, acyclovir and trimethoprim-sulfamethoxazole (TMP/SMP) (the latter after 30 days of age).
Perform HLA typing on parents and full siblings to evaluate as potential HCT donors; in absence of matched sibling, initiate search for an unrelated adult or cord blood donor.
