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Congenital Zika Infection: Assessment and Follow up of Infant Hearing

	Assessment of Infant Hearing: For infants testing positive for Zika virus infection thumbnail

Assessment of Infant Hearing

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Initial Hearing Evaluation for Infants with Possible or Confirmed Congenital Zika Infection

The initial evaluation of all infants born to mothers with laboratory evidence of Zika virus infection during pregnancy should include a standard newborn hearing screen.

  • Infants born to mothers with laboratory evidence of Zika virus infection during pregnancy
    • Perform a hearing screen per universal screening recommendations before hospital discharge.
  • Infants with laboratory evidence of Zika virus infection and abnormalities consistent with congenital Zika syndrome

    • Perform auditory brainstem response to assess hearing before 1 month of age.

Outpatient Management for Infants with Laboratory Evidence of Congenital Zika Infection

Recommendations for follow up of infants with laboratory evidence of congenital Zika virus infection depend on whether abnormalities consistent with congenital Zika syndrome are present. The risk of a delayed onset or progressive hearing loss after an initial normal hearing screen in infants with congenital Zika virus infection is unknown as of September 21, 2016.

Infants with laboratory evidence of congenital Zika virus infection

and

(a) microcephaly
or
(b) other findings consistent with congenital Zika syndrome

If the initial newborn hearing screen was performed using auditory brainstem response

  • Repeat auditory brainstem response testing at age 4 to 6 months
  • Refer to audiology for any abnormal findings or for any parental or provider concerns.

If the initial newborn hearing screen was performed using only otoacoustic emission (OAE)

  • Refer the infant for auditory brainstem response (ABR) screening before 1 month of age.
  • If hearing results are abnormal, refer to audiology as soon as possible
  • If the newborn hearing screen was normal, arrange for an ABR to be performed at age 4 to 6 months.

 

Infants with laboratory evidence of congenital Zika virus infection

but

Without findings consistent with congenital Zika syndrome.

  • Perform auditory brainstem response within one month of birth.
  • Consider repeat auditory brainstem response at age 4 to 6 months or perform behavioral diagnostic testing at age 9 months.
  • Refer to audiology for any abnormal findings or for any parental or provider concerns.

Infants with laboratory evidence of Zika virus infection but without apparent abnormalities at birth are recommended to have additional monitoring until further information is available regarding outcomes because some neurologic sequelae of congenital Zika virus infection (e.g., seizures, cognitive impairment, and vision and hearing abnormalities) might be subtle or have delayed onset.

Providers should also

  • Refer infants with abnormalities on initial hearing screen to an audiologist for a complete evaluation.
  • Consider ABR testing of infants at age 4 to 6 months, although the risk from sedation needs to be taken into account.
  • Refer infants who (a) passed an initial ABR and (b) did not have an ABR at age 4 to 6 months for behavioral audiologic diagnostic testing at age 9 months or sooner for any hearing concerns. Behavioral audiologic testing is recommended because of the potential need for sedation with ABR testing in infants.
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