Evaluation and Management of Neonates with Possible Congenital Zika Virus Infection

ABSTRACT

Zika virus infection is, typically, either asymptomatic or causes mild illness; however, it may present severe clinical manifestations in neonates. Zika virus can be transmitted from a pregnant woman to her fetus, subsequently causing microcephaly and serious brain anomalies. Recently, the full spectrum of anomalies in neonates congenitally infected by Zika virus has been delineated as congenital Zika syndrome. Five major features are unique to congenital Zika syndrome: severe microcephaly with a partially collapsed skull, thin cerebral cortices with subcortical calcifications, macular scarring and focal pigment mottling of the retina, congenital contractures, and extrapyramidal symptoms. Recognition of this phenotype in neonates and infants by clinicians can help ensure appropriate etiologic evaluation of Zika virus infection and determine the required duration of follow-up and clinical care. Neonates with congenital Zika virus infection should be evaluated by a team of multiple specialists within the first year of life; the evaluations should include assessments of vision, hearing, feeding, growth, and neurodevelopmental function. Moreover, it is recommended that infants who show laboratory evidence of congenital Zika virus infection without apparent abnormalities be continuously monitored and screened by the primary care provider; repeated hearing tests should be carried out for such infants.