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INFECTIOUS
DISEASES

tal specimens can be preserved within 48 hours of birth for later days. The incremental cost of comprehensive ZIKV-associated mi-
ZIKV testing, according to the CDC recommendations, while the crocephaly workup, including advanced brain imaging, laboratory
medical team is weighing the clinical evidence for congenital micro- testing, prolonged hospitalization, and specialty care costs, is pro-
cephaly or symptomatic infection and while the maternal testing is jected to be even higher. The emotional toll to families and the bur-
in progress. Even if the laboratory and radiologic workup is delayed den to human and laboratory resources is likely significant, too,
for a few days until the determination of microcephaly can be made, though difficult to quantify. The clinical exclusion of transient con-
it ought to be offered to candidate neonates before the initial dis- genital craniofacial asymmetries and cranial molding, via serial HC
charge from the birthing facility. Transient craniofacial asymmetries measurements, is a possible cost-effective first step in the diagnostic
and molding can be self-resolving, whereas ZIKV and other fetal workup of microcephaly.
and neonatal CNS pathogens may lead to nonreversible or progres- We conclude that standardized serial circumference measure-
sive microcephaly and to progressive and lifelong disabilities. Early ments of the newborn head are integral to the workup of transient
detection of infection, reliable follow-up, and access to specialty re- neonatal craniofacial asymmetries mimicking infection-induced con-
sources give the pediatrician and the parents an explanation for the genital microcephaly.
microcephaly and aim at enhanced quality of life for the patient.
Utilization of resources is becoming pronounced in known Drs. Tsakiri, Garcia, and Mazur are with the Department of Pediatrics
ZIKV endemic areas, such as South and Central America, in areas at UTHealth at Houston; and Dr Zacharias is with the Department of Ob-
of travel-associated exposure, and in areas of emerging local trans- stetrics and Gynecology at UTHealth at Houston. Send correspondence to
mission, such as Florida and Texas. Before the ZIKV epidemic, the Sophia Tsakiri, MD, Lyndon Baines Johnson General Hospital, 5656 Kelley
median hospital charge estimate for congenital microcephaly in Street, Suite 2NT-91-002g, Houston, TX 77026; email:
Texas was $22,754, and the median hospital length of stay was 5 Sophia.Tsakiri@uth.tmc.edu.

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