The day after she delivered a baby girl at Jackson Memorial Hospital in June, Maria Ramírez de Mendoza was ready to take her daughter home.
Little Micaela Milagros Mendoza weighed 8 pounds and one ounce, with a tuft of brown hair and rosy cheeks — and no visible sign that the Zika virus her mother had contracted during the third month of pregnancy had caused any complications.
“She was born perfect,” Mendoza said in Spanish.
But Mendoza and her husband, Omar, had to wait to go home with their baby, among the first born in the United States with Zika-related complications. It was apparent the baby didn’t have microcephaly, a condition characterized by an abnormally small head, but doctors were worried about what they couldn’t see.
Mendoza had tested positive for Zika in April after first experiencing symptoms, including a rash and body aches, in December. So doctors advised the 37-year-old native of Venezuela that her newborn needed a series of tests to measure the impact of the virus.
The CDC advises that Zika virus infection during pregnancy can cause certain birth defects, including microcephaly. But scientists do not know how likely it is that Zika infection will affect a pregnancy or if a baby will have birth defects if the mother is infected while pregnant.
Doctors kept Micaela at Jackson Memorial’s Holtz Children’s Hospital for two and a half weeks, Mendoza said. They put her through the tests: a cerebral ultrasound, then an MRI scan of her brain. They gave her a spinal tap, an eye exam and more.
“We had to wait,” Mendoza recalled Wednesday in an interview with the Miami Herald. “We kept having to wait. Wait is a word I would like to erase from my mind, but I can’t.”
An ultrasound showed some red flags: Micaela had pockets of calcification on one side of the frontal lobe of her brain. Another exam revealed a circle-shaped scar in the retina of her left eye — symptoms that can be caused by any number of viruses, such as rubella, toxoplasmosis, or cytomegalovirus, said Audina Berrocal, an ophthalmologist with the University of Miami Health System’s Bascom Palmer Eye Institute.
“It showed us that there was an infectious process in that area of the retina,” said Berrocal, who is part of UHealth’s Zika Response medical team caring for Micaela. “The calcifications are like the remnants of having had an infectious, inflammatory process in that area of the brain.”
After the battery of tests were completed and doctors had ruled out other potential causes, the only possible explanation was Zika.
“They gave me the baby and sent me home,” Mendoza said, “because there is no treatment for Zika.”
There is no treatment for Zika.
Maria Ramírez de Mendoza, mother of baby with Zika complications
Since going home with mom to Doral in mid-July, Micaela has led a normal life, Mendoza said. The baby, now eight weeks old, mostly sleeps and eats. She smiles when Mendoza makes cooing sounds, and sucks intently on a pacifier.
Mendoza said doctors have prescribed physical and occupational therapy at least twice a week for Micaela. She also will receive follow up treatment for the foreseeable future, such as electroencephalograms to measure electrical activity in her brain, and monthly measurements of her skull to gauge its growth.
Because the medical record does not contain much research on the physical and neurological development of children born with complications from Zika, however, doctors cannot be certain what to expect.
“Even in the absence of microcephaly,” Berrocal said, “you could have other Zika changes in the brain, and that’s what makes it a little scarier.”
The Zika outbreak in Brazil demonstrated that the virus’s impact on fetal development tends to be especially aggressive when it infects mothers in the first trimester of pregnancy. But Micaela, whom Berrocal calls “a pretty lucky baby,” was not impacted as severely as other infants born to mothers infected early in the gestational period.
“There’s so much about Zika that we don’t understand yet,” she said.
70 Pregnant women in Florida who have tested positive for Zika virus this year.
While the uncertainty keeps doctors and researchers busy, though, the Mendozas can only wait.
“We have to wait and see how much damage she may have to her brain,” Mendoza said. “Up until now, with all the tests they've done, she doesn’t have anything. To be sure, she has calcifications, but they don’t know how it will affect her because she’s a baby.”
Mendoza, who spent much of her pregnancy pained by uncertainty, said she has relied on her Catholic faith and the goodwill of friends in Miami to help keep her grounded as her emotions run from hopeful to despairing.
“This has been a pregnancy that has been, not sad, but very difficult,” she said, her eyes filling with tears. “I wouldn’t want any mom to be in my situation.”
The baby’s middle name is Milagros, the Spanish word for miracles, Mendoza said, because she made a promise to honor the Virgin Mary if her child were not harmed by the virus.
Since Micaela’s birth, Mendoza’s husband and three young children have returned to Venezuela, where they are eagerly awaiting the day when the family can reunite.
“They’re thrilled with their sister,” Mendoza said of her three other children, a 13-year-old daughter and 9-year-old twin boys.
Mendoza said she plans to stay in South Florida, where Micaela can receive quality medical care. She said doctors in Venezuela were unable to confirm her Zika infection when she first broke out with symptoms, including a rash and body aches, in December. They also advised her that even if it were Zika, her unborn baby would not be affected, she said.
Then Mendoza saw a CNN report in January that Zika can cause microcephaly. “That’s when the nightmare began,” she said.
This week, still uncertain about her daughter’s future and anxious to find answers, Mendoza took Micaela to Nicklaus Children’s Hospital for a second opinion. She said a pediatric infectious disease specialist at Nicklaus Children’s gave her the same advice as the doctors at Jackson Memorial and Bascom Palmer.
Berrocal said there’s a good chance that Micaela’s still-developing brain and body will find a way to compensate for the effects of Zika because neural tissue in babies and children has “a way of remodeling itself” that adult tissue does not have.
“There’s a pretty good chance,” Berrocal said, “that she’s going to be minimally affected by the Zika virus.”