CDC Updates Guidance for Care of Infants Born to Mothers with Possible Zika Virus Infection During Pregnancy

The Centers for Disease Control and Prevention (CDC) today issued updated interim clinical guidance for health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy.

The revised guidance updates recommendations for the initial evaluation and testing of infants born to mothers with laboratory evidence of possible Zika virus infection during pregnancy, based on information that has become available since release of the previous guidance in February. This guidance also includes recommendations for the management, referral to services, and follow-up of infants with laboratory evidence of congenital Zika virus infection, with or without apparent associated birth defects. The updated recommendations are these:

• The updated guidance does not include dengue testing and recommends against testing cord blood specimens.
• The new guidance provides information on how infant laboratory testing results should be interpreted.
• The previous guidance recommended performing a cranial ultrasound unless prenatal ultrasound results from the third trimester demonstrated no abnormalities of the brain. The updated guidance recommends a cranial ultrasound even if the prenatal ultrasound was normal.
• Beyond initial evaluation, the previous guidance only recommended considering an additional hearing screen at 6 months, and evaluating head circumference and developmental milestones throughout the first year of life. The updated guidance provides additional recommendations for the outpatient management of infants through the first year of life.
• The updated guidance emphasizes the importance of establishing a medical home and of providing support for families affected by Zika.
• Repeat eye and hearing assessments and a new recommendation for endocrine (hormonal) evaluation are new in the updated guidance.

Because the types of services needed to care for infants with congenital Zika syndrome are complex, CDC recommends coordinated care through a multidisciplinary team and established medical home. As a critical component of patient care and early identification of any delays, families should be empowered to be active participants in their child’s monitoring and care. CDC has developed a webpage on resources for affected families. HHS has also developed a planning resource for jurisdictions to assist in their preparedness and response efforts related to services and supports for children with special health care needs and will be updating this resource in the coming weeks.

Based on currently available data on congenital infections with Zika and other pathogens, this guidance aims to assist health care providers in the testing of infants with confirmed or possible congenital exposure to Zika virus and in the evaluation and management of infants with a diagnosis of confirmed or probable congenital Zika virus infection. CDC, in collaboration with the American Academy of Pediatrics (AAP), convened a meeting of experts to obtain individual input on the testing of infants with confirmed or possible congenital exposure to Zika virus and the clinical evaluation and management of infants diagnosed with confirmed or probable congenital Zika virus infection in the United States. CDC took these discussions into consideration when developing the updated interim guidance. As more information becomes available, this guidance will be updated.

For more information, visit: http://www.cdc.gov/mmwr/volumes/65/wr/mm6533e2.htm?s_cid=mm6533e2_w

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES