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The page below is a sample from the LabCE course Zika Virus: Overview and Laboratory Testing. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Newborn Management, Evaluation, and Follow-up

Both the CDC and WHO recommend careful clinical evaluation of these infants before making a definitive diagnosis of microcephaly and determining appropriate follow-up. Laboratory testing for congenital Zika virus infection is recommended for infants born to mothers with laboratory evidence of Zika virus infection and for infants with findings suggestive of congenital Zika syndrome and a maternal epidemiologic link suggesting possible transmission, regardless of maternal testing results.
The CDC recommends that infants be assessed and tested for Zika virus infection under the following circumstances:
  • If infant is born to mothers with risk factors for maternal Zika virus infection, such as travel to or residence in an area of Zika virus transmission.
  • If the mother has had sex with a partner with travel to or residence in such an area.
  • If mother did not have maternal testing for Zika virus prior to delivery but traveled to or resided in such as area.
Infants should be given a comprehensive physical exam and careful measurement of head circumference. If not already done, maternal testing for Zika virus should be performed and testing of the placenta for Zika virus should also be considered. If the infant appears clinically well and normal, further evaluation and infant testing can be deferred until maternal test results are available. However, if there is concern about infant follow-up, then infant testing for Zika virus should be performed before hospital discharge.
The CDC indicates that laboratory evidence of maternal Zika virus infection includes Zika virus RNA detected in any maternal clinical specimen by real time reverse transcriptase-polymerase chain reaction (rRT-PCR) and positive Zika virus IgM with confirmatory neutralizing antibody titer for Zika virus or flavivirus, not otherwise specified.
In addition, Zika virus rRT-PCR testing should be performed on both infant serum and urine, and Zika virus IgM (ELISA) should concurrently be performed on infant serum. Laboratory testing should be performed on infant specimens; however, cord blood is not recommended because it can yield false positive results through contamination with maternal blood and might also yield false negative results. Infant laboratory testing for Zika virus should be performed within the first two days after birth. However, if testing is performed later, distinguishing between congenital, perinatal, and postnatal infection will be difficult. The CDC stresses that If the timing of infection cannot be determined, infants should be managed as if they have congenital Zika virus infection.