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Postnatal Care

CDC guidance provides testing and care recommendations for infants with possible Zika virus infection, briefly outlined below.

Guidance for the evaluation of infants with congenital Zika virus exposure has been previously published; infants who meet one or more of the published criteria for testing for congenital Zika virus infection, should be tested and evaluated in accordance with the updated CDC interim guidance for the evaluation and management of infants with possible Zika virus infection. It is critical that pediatric health care providers inquire about possible maternal and congenital Zika virus exposure for every newborn. The updated interim guidance updates recommendations for the diagnosis, evaluation, and follow-up of infants in three main groups.

  • Infants born to mothers with possible Zika virus exposure during pregnancy who meet one or more of the published criteria for testing for congenital Zika virus infection: Test and evaluate in accordance with the updated CDC interim guidance for the evaluation and management of infants with possible Zika virus infection. This should include a comprehensive physical examination, Zika virus testing, and a newborn hearing screening, preferably using automated brainstem response (ABR) methodology. Infants should also receive a head ultrasound and a comprehensive ophthalmologic exam by one month of age. Families should be referred to a developmental specialist and early intervention services, and consultations with specialists including an infectious disease specialist, a clinical geneticist, and a neurologist should be considered.
  • Infants born to mothers with laboratory evidence of Zika virus infection during pregnancy but without abnormalities related to congenital Zika syndrome: Test and evaluate in accordance with the updated CDC interim guidance for the evaluation and management of infants with possible Zika virus infection. This should include a comprehensive physical examination, Zika virus testing, and newborn hearing screening, preferably using automated brainstem response (ABR) methodology. Infants should also receive a head ultrasound and a comprehensive ophthalmologic exam by one month of age. If positive for Zika virus infection, infants should receive care according to the recommendations for infants with abnormalities consistent with congenital Zika syndrome.
  • Infants born to mothers with possible Zika virus exposure during pregnancy but without laboratory evidence of Zika virus infection during pregnancy: Testing and clinical evaluation for Zika virus infection beyond a standard evaluation is not recommended. This group includes infants of mothers who were never tested during pregnancy as well as mothers whose test result was negative because of issues related to timing or accuracy of the test. Because the latter issues are not easily discerned, all mothers with possible exposure to Zika virus during pregnancy who do not have laboratory evidence of possible Zika virus infection, including those who tested negative with currently available technology, should be considered in this group. If findings suggestive of congenital Zika syndrome are identified at any time, refer to appropriate specialists and evaluate for congenital Zika virus infection.

Pathologic evaluation of fetal tissue specimens (e.g., placenta and umbilical cord), is another important diagnostic tool to establish the presence of maternal or congenital Zika virus infection and can provide a definitive diagnosis of Zika virus infection in certain scenarios when Zika virus-associated birth defects are present. In addition, findings from pathologic evaluation might also be helpful in evaluating some pregnant women who seek care >12 weeks after symptom onset or possible exposure. For additional pathology testing recommendations, refer to CDC’s updated interim guidance.

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