Congenital Zika: Updated Guidance for the Care of Infected Infants

August 28, 2016

Congenital Zika: Updated Guidance for the Care of Infected Infants

  1. Deborah Lehman, MD

The CDC has released detailed recommendations for caring for congenitally infected infants.

  1. Deborah Lehman, MD

Sponsoring Organization: U.S. Centers for Disease Control and Prevention (CDC)

Target Audience: Pediatric and family medicine clinicians

Background and Objective

Congenital Zika infection can result in a wide spectrum of structural and functional abnormalities. These range from microcephaly and other brain abnormalities leading to neurologic deficits, seizure disorders, hearing and vision abnormalities, and developmental delay. Developed with input from a multidisciplinary task force, the CDC has now published updated recommendations for the initial and ongoing clinical and laboratory evaluation of infants born to women with documented Zika infection or with signs suggestive of congenital Zika infection with the appropriate maternal exposure history. All infants who undergo testing should be reported to the Zika Pregnancy Registries in the United States (http://www.cdc.gov/zika/hc-providers/registry.html) or in Puerto Rico (http://www.cdc.gov/zika/public-health-partners/zapss.html).

Key Recommendations

Laboratory testing:

  • Real-time reverse transcription–polymerase chain reaction (rRT-PCR) in the first two days of life on serum and urine

  • Zika immunoglobulin M confirmed with plaque neutralizing antibody testing

Clinical examination:

  • Comprehensive physical exam with special attention to head (occipitofrontal) circumference and neurological examination

  • Complete blood count and comprehensive metabolic panel

  • Head ultrasound

  • Auditory brainstem response testing

Subspecialty consultations:

  • These should include ophthalmology, infectious diseases, neurology, endocrinology, and genetics.

Care coordination/referrals:

  • Infants with confirmed infection require identification of a medical home for coordination of complex care and referrals to developmental specialists, early intervention services, and social support for families.

Comment

As Zika spreads throughout the Americas, a significant increase is expected in the number of infected and affected infants. These recommendations for the evaluation, management, and subspecialty referral of such infants are key to the complex care these infants will require. Continued efforts focusing on prevention are critical to stemming this devastating congenital infection.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Leadership positions in professional societies AAP PREP The Course (Member, Planning Committee)

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