Updated guidelines from the CDC recommend Zika virus testing for infants born to mothers who have laboratory features of exposure to Zika virus and to infants who have clinical features of infection (microcephaly, intracranial calcifications, eye anomalies and other neurologic abnormalities) along with maternal epidemiological risk factors, even if the mother’s lab tests are negative. Lab tests to be done in the infant serum and urine in the first two days of life (and not on cord blood) are: molecular (real-time reverse transcription-polymerase chain reaction [rRT-PCR]) and serologic (immunoglobulin M [IgM]) testing. A positive infant serum or urine rRT-PCR test result confirms congenital Zika virus infection. A positive Zika IgM test, with a negative rRT-PCR, indicates probable congenital Zika virus infection. All neonates suspected with Zika should have a comprehensive physical and neurologic examination, postnatal head ultrasound, and standard newborn hearing screen.