Margaret Feeney, MD

1. 3/9/2016
Birth Defects and
Pediatric Care Guidelines
Margaret Feeney, MD

2. Microcephaly reporting in Brazil

5. Autopsy Findings

6.  Pregnant women in Rio; rash within
past 5 days
 Tested blood and urine RT-PCR
 72/88 (82%) tested Zika+
 Acute infections at 5-38 wks GA
 Maternal illness mild
 Fetal ultrasound in 42
 Abnormalities in 12 (29%; vs. none
in those who tested Zika-negative)
• 2 fetal deaths (36, 38wks GA)
• IUGR+/-microcephaly (5 infants)
• Calicifications, other CNS (7 infants)
• Abnl AF volume / cord flow (7 infants)
3/9/20166

7. Week of Gestation at Infection: Risk of Fetal Anomalies
3/9/20167

8. Microcephaly primarily results from 1st or 2nd trimester infection
3/9/20168

9. Sequelae of Late Infection
3/9/2016Presentation Title and/or Sub Brand Name Here9
IUGR, microcephalyFetal death
Fetal death
Anhydramnios,
IUGR
Cerebral calcifications,
Ventriculomegaly, brachycephaly

10.  29 infants with microcephaly + Zika in Bahia, Brazil
• Ocular abnormalities were seen in:
‒ 10/29 children (35%), or 17/58 eyes (29%)
• Most common were:
‒ Focal pigment mottling of retina and chorioretinal atrophy (65%)
‒ Optic nerve abnormalities (47%)
‒ Bilateral iris coloboma (12%)
‒ Lens subluxation (6%)

11. 11
R: Pigmentary mottling in the macula
L: Chorioretinal lobulated atrophic lesion
R: Pigmentary mottling in the macula;
enlarged cup: disk ratio
L: Macular chorioretinal atrophic lesion
with a hyperpigmented halo
R: Optic disc hypoplasia, excavated nasal
round lesion with hyperpigmented halo and
colobomatous-like aspect
L: similar findings
Retinal findings:

12. Clinical evaluation

16. Follow-up of infants with congenital Zika
 Report case to state/local health Dept
 Ophtho exam
 F/u any abnormalities on hearing screen and repeat screen at 6 mos
 Carefully track head circumference and developmental milestones
 Refer as needed to neurology, developmental specialists, PT,
audiology, speech therapy

17. Summary
 Prenatal infection can results in a spectrum of brain and ocular
malformations; most clinically evident is microcephaly
 The proportion of congenitally infected infants with abnormalities
appears to be high
 Full spectrum of pediatric disease is unknown
 Exact developmental window of vulnerability not determined
 Potential risks posed by postnatal infection and/or breastmilk
acquisition are unknown