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MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):870-878. doi: 10.15585/mmwr.mm6533e2.

Update: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection - United States, August 2016.

Author information

1
Boston Children's Hospital.
2
RTI International.
3
University of Utah.
4
Administration for Children and Families.
5
Augusta University.
6
Family Voices, Inc.
7
Seattle Children's Hospital.
8
Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services.
9
CDC.
10
Tift Regional Health System.
11
Texas Department of State Health Services.
12
Duke University.
13
University of Pittsburgh.
14
Cincinnati Children's Hospital.
15
University of Rochester Medical Center.
16
Office of the Assistant Secretary for Health.
17
National Institute of Child Health and Human Development.
18
Nemours Children's Health System, Sidney Kimmel Medical College of Thomas Jefferson University.
19
Maternal and Child Health Bureau, Health Resources and Services Administration.
20
Stanford University.
21
March of Dimes.
22
University of Chicago.
23
Florida State University College of Medicine.
24
University of Chicago Medicine-Comer Children's Hospital.
25
Elizabeth Glaser Pediatric AIDS Foundation.
26
Parent to Parent of Georgia.
27
Healthcare Network of Southwest Florida.
28
University of Arizona.
29
University of Florida.
30
Emory University.
31
University of California, San Diego.
32
Nationwide Children's Hospital.
33
University of Mississippi Medical Center.
34
University of Texas Southwestern Medical Center.
35
University of Wisconsin, Madison.
36
American Academy of Pediatrics (AAP.
37
Vanderbilt University School of Medicine.
38
Altino Ventura Foundation.
39
Children's of Alabama,, University of Alabama at Birmingham.
40
Cincinnati Children's Hospital Medical Center.
41
Puerto Rico Chapter, AAP.

Abstract

CDC has updated its interim guidance for U.S. health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy (1). Laboratory testing is recommended for 1) infants born to mothers with laboratory evidence of Zika virus infection during pregnancy and 2) infants who have abnormal clinical or neuroimaging findings suggestive of congenital Zika syndrome and a maternal epidemiologic link suggesting possible transmission, regardless of maternal Zika virus test results. Congenital Zika syndrome is a recently recognized pattern of congenital anomalies associated with Zika virus infection during pregnancy that includes microcephaly, intracranial calcifications or other brain anomalies, or eye anomalies, among others (2). Recommended infant laboratory evaluation includes both molecular (real-time reverse transcription-polymerase chain reaction [rRT-PCR]) and serologic (immunoglobulin M [IgM]) testing. Initial samples should be collected directly from the infant in the first 2 days of life, if possible; testing of cord blood is not recommended. A positive infant serum or urine rRT-PCR test result confirms congenital Zika virus infection. Positive Zika virus IgM testing, with a negative rRT-PCR result, indicates probable congenital Zika virus infection. In addition to infant Zika virus testing, initial evaluation of all infants born to mothers with laboratory evidence of Zika virus infection during pregnancy should include a comprehensive physical examination, including a neurologic examination, postnatal head ultrasound, and standard newborn hearing screen. Infants with laboratory evidence of congenital Zika virus infection should have a comprehensive ophthalmologic exam and hearing assessment by auditory brainstem response (ABR) testing before 1 month of age. 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. Infants with abnormalities consistent with congenital Zika syndrome should have a coordinated evaluation by multiple specialists within the first month of life; additional evaluations will be needed within the first year of life, including assessments of vision, hearing, feeding, growth, and neurodevelopmental and endocrine function. Families and caregivers will also need ongoing psychosocial support and assistance with coordination of care. Infants with laboratory evidence of congenital Zika virus infection without apparent abnormalities should have ongoing developmental monitoring and screening by the primary care provider; repeat hearing testing is recommended. This guidance will be updated when additional information becomes available.

PMID:
27559830
DOI:
10.15585/mmwr.mm6533e2
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