CDC & AAP update recommendations for infants with Zika virus infection
Dr K K Aggarwal
The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) and have updated recommendations for the clinical evaluation and management of infants suspected of having Zika infection and those who have congenital Zika virus infection. These recommendations followed an expert level meet on July 21 to discuss revisions to the last CDC recommendations, released in February 2016.
The three main areas touched were evaluation of infants with suspected or confirmed congenital Zika virus infection, outpatient care and follow-up for symptomatic infants with congenital Zika virus infection, and outpatient care and follow-up for infants without apparent abnormalities at birth.
Infants suspected to have congenital Zika infection
· Infection is considered to be possible or confirmed if infant PCR or IgM testing results are positive (final recommendations on this awaited).
· A comprehensive physical examination should include careful head circumference measurement and assessment of length, weight, and gestational age; and evaluation for neurologic abnormalities, dysmorphic features, liver or spleen enlargement and the presence of rash or other skin lesions.
· A hearing screen per universal screening and a cranial ultrasound should be done before discharge.
· The infant should be examined within a month of birth by a pediatric ophthalmologist.
· A complete blood count to check for thrombocytopenia should be done.
Symptomatic infants with congenital Zika infection
· Standard precautions should be followed when handling body fluids.
· Lab work should include CBC and a complete metabolic panel including liver function tests (LFTs).
· Careful assessment of head circumference, length, and weight at birth, monthly until age 6 months, and then as required. Head circumference in infants with severe microcephaly should be measured from the glabella to the point of the occipital bone. But, one must remember that the head size may be normal in infants with congenital Zika infection.
· Ophthalmology and hearing screen before discharge; repeat hearing screen at 4 to 6 months of age if normal at birth. If normal ophthalmology screening at birth, it should be repeated at age 3 months, including retinal exam.
· Head USG before discharge; CT and MRI as needed.
· Follow up every month; these infants should receive regularly scheduled immunizations. Pertussis-containing immunizations are not contraindicated in children with central nervous system malformations, but uncontrolled seizures may be a precaution for vaccines containing pertussis.
· Developmental screening at each visit; complete neurological exam to be done at 1 and 2 months and as necessary thereafter.
· Screen for central hypopituitarism/hypothalamic dysfunction
· These infants should be under the care of multidisciplinary team.