Key Pediatric Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 10, 2018

In This Article

Congenital Zika in Infants

Centers for Disease Control and Prevention

Zika virus nucleic acid testing (NAT) should be offered as part of routine obstetric care to asymptomatic pregnant women with ongoing possible Zika virus exposure (residing in or frequently traveling to an area with risk for Zika virus transmission); serologic testing is no longer routinely recommended because of the limitations of IgM tests, specifically the potential persistence of IgM antibodies from an infection before conception and the potential for false-positive results. Zika virus testing is not routinely recommended for asymptomatic pregnant women who have possible recent, but not ongoing, Zika virus exposure.

Zika virus testing is recommended for infants with clinical findings consistent with congenital Zika syndrome and possible maternal Zika virus exposure during pregnancy, regardless of maternal testing results. Testing CSF for Zika virus RNA and Zika virus IgM antibodies should be considered, especially if serum and urine testing are negative and another etiology has not been identified.

In addition to a standard evaluation, infants with clinical findings consistent with congenital Zika syndrome should have a head ultrasound and a comprehensive ophthalmologic exam performed by age 1 month by an ophthalmologist experienced in assessment of and intervention in infants. Infants should be referred for automated auditory brainstem response (ABR) by age 1 month if the newborn hearing screen was passed using only otoacoustic emissions methodology.

Zika virus testing is recommended for infants without clinical findings consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy.

In addition to a standard evaluation, infants who do not have clinical findings consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy should have a head ultrasound and a comprehensive ophthalmologic exam performed by age 1 month to detect subclinical brain and eye findings.

A diagnostic ABR at 4 to 6 months or behavioral audiology at age 9 months is no longer recommended if the initial hearing screen is passed by automated ABR, because of absence of data suggesting delayed-onset hearing loss in congenital Zika virus infection.

References

  • Kelly JC. New CDC guidance on caring for infants with congenital Zika. Medscape News. WebMD Inc. October 20, 2017.

  • Update: Interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection—Unites States, October 2017. MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-99.

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