The Centers for Disease Control and Prevention (CDC) has updated its interim guidance for US healthcare providers caring for infants born to mothers with possible Zika virus infection during pregnancy. The guidance includes updated recommendations for the initial laboratory testing and evaluation of infants with possible congenital Zika virus infection as well as those for outpatient management of infants with laboratory evidence of Zika virus infection and abnormalities consistent with congenital Zika syndrome. Recommendations for management, referral to services, and follow-up of care are also included. The updated recommendations include:

• The updated guidance does not include dengue testing and recommends against testing cord blood specimens.

• The new guidance provides information on how infant laboratory testing results should be interpreted.

• The previous guidance recommended performing a cranial ultrasound unless prenatal ultrasound results from the third trimester demonstrated no abnormalities of the brain. The updated guidance recommends a cranial ultrasound even if the prenatal ultrasound was normal.

• Beyond initial evaluation, the previous guidance only recommended considering an additional hearing screen at 6 months, and evaluating head circumference and developmental milestones throughout the first year of life. The updated guidance provides additional recommendations for the outpatient management of infants through the first year of life.

• The updated guidance emphasizes the importance of establishing a medical home and of providing support for families affected by Zika.

• Repeat eye and hearing assessments and a new recommendation for endocrine (hormonal) evaluation are new in the updated guidance.