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Caring for Infants & Children

Notice: On October 20, 2017, CDC released updated interim clinical guidance for healthcare providers caring for infants born to mothers with possible Zika virus infection during pregnancy.

Changes in guidance include

  • To assist healthcare providers with evaluation, diagnosis, and clinical management decisions, infants have been categorized into three main groups: 1) infants with birth defects consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure during pregnancy; 2) infants without birth defects consistent with congenital Zika syndrome, but who were born to mothers with laboratory evidence of possible Zika virus infection during pregnancy; and 3) infants without birth defects consistent with congenital Zika syndrome born to mothers with possible congenital Zika virus exposure during pregnancy but without laboratory evidence of Zika virus infection.
  • The new guidance provides updated information on how infant laboratory testing results should be interpreted.
  • Recommendations for vision and hearing screening have been updated.
  • Some of the previously recommended screenings (e.g., thyroid screening, complete blood count [CBC], liver function tests [LFTs], hearing screening at 4-6 months) are no longer recommended because data are lacking to show that these screenings might be needed.
  • For infants with birth defects consistent with congenital Zika syndrome, healthcare providers should monitor for an expanded listed of potential problems. In addition, initial and follow-up care of these infants are no longer dependent on the infant’s Zika virus testing results.
  • For infants without birth defects consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy, an ophthalmologist should perform an eye examination.
  • For infants without birth defects consistent with congenital Zika syndrome born to mothers with exposure to Zika virus but no laboratory evidence of Zika virus infection during pregnancy, further testing for Zika virus and clinical evaluation are not recommended.

Summary

  • All infants born to mothers with possible exposure to Zika virus during pregnancy should receive a standard evaluation at birth and at each well-child visit. A standard evaluation should include a comprehensive physical exam (including growth parameters), age-appropriate vision screening and developmental screening and monitoring, and a standard newborn hearing screening at birth, preferably using auditory brainstem response (ABR) methodology.
  • Testing is recommended for infants with birth defects consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure during pregnancy (regardless of the mother’s Zika virus testing results) and for infants without birth defects consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection during pregnancy.
  • For infants who are recommended to receive testing for congenital Zika virus infection, concurrent Zika virus RNA nucleic acid testing (NAT) of serum and urine and Zika virus IgM testing of serum should be performed within a few days after birth, if possible. However, testing specimens collected within the first few weeks to months after birth may still be useful in the evaluation for possible congenital Zika virus infection.
  • Guidance for testing and clinical management of infants and children with postnatal Zika virus infection is in line with testing and clinical management recommendations for adults.
  • Zika virus PCR and serologic testing is recommended during the first 2 weeks after symptom onset to diagnose postnatal Zika virus disease. Serologic testing is recommended 2-12 weeks after symptom onset.

Featured Tools

Testing and Evaluation Tools

Use these tools to guide evaluation and testing of infants with possible congenital Zika virus infection.

Use these tools to guide evaluation and testing of infants with possible congenital Zika virus infection.

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Video

Cynthia A. Moore, MD, PhD with her Medscape video commentary on congential Zika and what to do next.

In this Medscape video, CDC expert, Dr. Cynthia Moore, discusses CDC guidance for caring for infants with congenital Zika exposure.

Watch the video

Patient Materials

Use these materials when counseling patients about Zika.

Use these materials when counseling patients.

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