Zika virus is a cause of microcephaly
and other severe fetal brain
abnormalities all infants born to
mothers with laboratory evidence of
confirmed or possible Zika virus
infection during pregnancy should
receive a comprehensive physical exam
including measurement of head
circumference length and weight and
assessment of gestational age a
neurologic examination a head ultrasound
to assess the brain structure a standard
newborn hearing screen and testing for
Zika virus infection before hospital
discharge this video will show
clinicians how to measure an infant's
head and lymph microcephaly is a birth
defect in which an infant's head is
smaller than expected when compared with
infants of the same sex and age or the
same gestational age microcephaly is
typically defined as an occipital
frontal circumference or head
circumference below the third percentile
for gestational age and sex
however standards can vary microcephaly
is a clinical finding not a diagnosis
head circumference is considered a
reliable assessment of the volume of the
underlying brain to assess an infant for
microcephaly a clinician measures a
newborn's head circumference it is
important that healthcare providers
measure head circumference in the same
way consistently to accurately identify
if an infant has microcephaly this is
especially important in the midst of the
Zika outbreak because correctly
identifying infants who may have Zika
associated microcephaly can help health
authorities connect them to the services
they need measuring head circumference
isn't always as simple as it sounds
let's review important considerations
and methods now first start with a
measuring tape that cannot be stretched
next securely wrap the tape around the
widest possible circumference of the
head that's usually one to two finger
widths above the eyebrow on the forehead
and then across the most prominent part
of the back of the head as you can see
here we recommend that you reposition
the tape and repeat the measurements
three times record the largest
measurement to the nearest 0.1
centimetres measuring length ideally
should be completed by two healthcare
providers to measure length lay the
infant face up on an infant ometer the
first health care provider correctly
positions a newborn's head against the
head plate and gently holds the head in
this position the second health care
provider gently presses the infant's
knees to straighten the legs then he or
she should press the bottom of the foot
onto the foot plate so that there is no
gap between the foot and the foot plate
record the length of the infant by
reading the measurement on the infant
ometer if an infant ometer is not
available a non stretchable measuring
tape can be used positioning the
infant's head against a wall or other
vertical flat surface is the best way to
mark the head position the infant's legs
are then extended as before the heel
position is marked and the distance from
the wall to the infant's heel is
measured with the tape
the presence of molding cephalo hematoma
or other factors related to delivery can
affect the accuracy of head
circumference measurements the time
required for these factors to resolve
can vary head circumference measurements
taken after the first 24 hours of life
may be more indicative of the true head
size however most measures of head
circumference at Birth from reference
charts by age and sex are based on
measurements taken no later than 24
hours after birth the most important
factor is that the head circumference is
carefully measured and documented at
some point during the first week of life
head circumference is one of three
important growth parameters to measure
at birth
the diagnosis of microcephaly refers
only to the head circumference therefore
it is essential to measure the other
growth parameters birth weight and birth
length to assess the infant's overall
growth pattern although the finding of a
proportionately small size and all three
growth parameters is of concern and
should be investigated in the context of
possible congenital Zika virus infection
there are many possible ideologies that
could also cause the same growth pattern
the occurrence of a head circumference
that is disproportionately small
compared to the other measurements is
more indicative of a specific problem
with brain development infants with
abnormalities consistent with congenital
zika syndrome should also receive
follow-up care according to CDC's latest
guidance which is updated as new
information becomes available the latest
guidance can be found on CDC's
Zika website our top priority for the
Zika response is protecting pregnant
women we also are working to ensure that
infants with microcephaly and other
brain abnormalities receive the services
they need accurately identifying infants
with microcephaly is crucial we hope
that this instructional video has
provided you with the tools you need to
accurately measure
circumference and infant length for more
information about Zika including
clinical guidance and tools for health
care providers please visit CDC's
website at cdc.gov slash Zika