As a result of a forum convened with the American academy of Pediatrics and the American Academy of Obstetricians and Gynecologists, the Centers for Diseases and Control (CDC) published new clinical management guidelines for Zika infants. Ever since the Zika infection was recognized as a public threat, physicians have been reporting post-natal complications like eye abnormalities, incident microcephaly in infants with a normal head circumference at birth and diaphragmatic paralysis. This update used clinical data collected up to September 2017 and will be revised again.
Infants born to mothers with possible Zika infection and who exhibit some of the above-mentioned symptoms should be tested with specific serum and urine tests; if they come out negative, they should have a CSF sample tested for Zika RNA and IgM Zika antibodies. At age one month, they should have a head ultrasound, a comprehensive ophthalmologic examination and auditory brainstem audiometry.
The ophthalmologic exam should pick up any of the following anomalies:
- Intraocular calcifications
- Optic nerve hypoplasia and atrophy
- Macular scarring with focal pigmentary retinal mottling
The ABR audiometry must be done at one month because the Zika virus infection can produce sensorineural hearing loss; its late onset has not been documented.
As epileptic activity can be part of the Zika syndrome, the infants at risk must have a complete neurological examination to detect some subclinical EEG abnormalities. An MRI of the brain can detect subtle brain abnormalities like the following;
- Cortical thinning
- Corpus Callosum abnormalities
- Calcifications at the junction of white and gray matter
- Ventricular enlargement
As they grow, these infants must be periodically examined for clinical signs of increased intracranial pressure, an ominous sign of a developing hydrocephalus.
There is a large group of infants without clinical signs of congenital Zika and who were born to mothers with possible exposure to the virus in their pregnancies but without laboratory evidence of an infection that pose a clinical challenge for the medical personnel. There are some socio-economic variables like the lack of proper testing or inadequate laboratory facilities that produce false-negative test results. The CDC does not approve of further testing in these infants unless worrisome clinical symptoms appear later and subject to discussion with the caring personnel.
Serial ultrasound examinations can be cumbersome and expensive; the use of amniocentesis carries the certain risk of fetal loss and/or damage. Any testing must be a shared-decision between the professionals, patients and their families.
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