Congenital Zika syndrome happens when a mother is infected with Zika virus during pregnancy, mostly through mosquito bites, and the virus damages the developing brain. Babies can be born with severe microcephaly, eye damage and stiff joints, and they need long-term care from several specialists.
Key symptoms
- Very small head at birth
- Irritability, excessive crying or seizures
- Feeding and swallowing problems
- Stiff limbs and trouble moving
- Poor vision or hearing noticed by parents
What you find on exam
- Head circumference below the 3rd percentile, with a partly collapsed skull
- Extra folds of scalp skin
- Joint contractures such as clubfoot or bent fingers
- High muscle tone and brisk reflexes
- Abnormal red reflex or eye findings
Tests
- Zika RNA PCR on infant serum and urine and Zika IgM, in the first days of life
- Head ultrasound, CT or MRI: brain calcifications and thin cortex
- Dilated eye exam by an ophthalmologist
- Hearing test with auditory brainstem response
Treatment basics
- No antiviral; care is supportive and lifelong
- Team care: neurology, ophthalmology, audiology and developmental therapy
- Antiseizure medicines when seizures occur
- Feeding support and growth tracking; feeding tube if needed
- Prevention in pregnancy: avoid travel to outbreak areas, repellent and condoms
Red flags
- Seizures
- Choking or coughing with feeds, which suggests aspiration
- Poor weight gain or dehydration
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.