Zika in Newborns: A Q&A for Clinicians

Laurie Scudder, DNP, PNP


February 03, 2016

Editor's Note:
The explosive rise in the number of cases of Zika virus infection, centered in Latin America and the Caribbean, prompted the US Centers for Disease Control and Prevention (CDC), in conjunction with the American Academy of Pediatrics (AAP), to issue interim guidelines[1] in January for the evaluation, testing, and management of infants with possible congenital Zika virus infection. While endemic infections have not been reported in the United States, cases have been reported in 23 countries, and the CDC has issued a travel alert for individuals traveling to these countries. As warmer weather approaches, parts of the United States, particularly in the South, may see limited outbreaks.

Zika exposure during pregnancy has been linked to a recent surge in cases of microcephaly or intracranial calcifications detected prenatally or at birth. The guidelines address care of these infants. The document also provides information on the care of infants without these findings who are born to mothers who, while pregnant, traveled to or resided in an area with Zika virus transmission.

The CDC recently posted a Q&A for pediatric healthcare providers addressing issues in caring for infants with known or suspected Zika exposure. Excerpts from that more extensive document are provided below. The full text can be found on the CDC website.

Congenital Zika Infection and Microcephaly

What is the link between Zika virus in Brazil and the high numbers of infants born there with microcephaly?

Zika virus infections have been confirmed in several infants with microcephaly from Brazil. The time frame and geographic location of reports of infants with microcephaly coincides with the outbreak of Zika virus infections in Brazil. The baseline prevalence of congenital microcephaly is difficult to determine because of underreporting, and the inconsistency of clinical criteria used to define microcephaly. Although population-based estimates of congenital microcephaly in Brazil vary, the number of infants with microcephaly currently being reported in Brazil is greater than would be expected.

What birth defects have been reported in in infants with confirmed Zika virus infection?

Brain abnormalities reported in infants with microcephaly and laboratory-confirmed congenital Zika infection include microcephaly and disrupted brain growth. Some infants with possible Zika virus infection have been found to have intracranial calcifications and abnormal eye findings. It is not known if Zika virus infection caused any of these abnormalities.

What birth defects have been reported in infants with suspected Zika virus infection?

A report of 35 infants with microcephaly who were born during an outbreak of Zika virus infection in Brazil in 2015 described the following brain abnormalities: intracranial calcifications, ventriculomegaly, and neuronal migration disorders (lissencephaly and pachygyria). Other anomalies included congenital contractures and clubfoot. An important distinction is that neither these infants nor their mothers had laboratory-confirmed Zika virus; however, most of the mothers (~75%) reported symptoms consistent with Zika virus.


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