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On 2 December 2015 the criterion for diagnosis changed to 32 cm or less for infants of gestational age 37 weeks or more, or, for preterm infants, 2 standard deviations below the mean for age and sex on the Fenton curve.According to the Brazilian Ministry of Health’s protocol pandora charms, all infants born with suspected microcephaly in Pernambuco should be referred to one of two paediatric infectious disease departments and to one of four rehabilitation centres. The Association for Assistance of Disabled Children (AACD) is one of the rehabilitation centres. All investigations described in this report were conducted as part of the routine clinical evaluation of these children as established by clinical protocols defined by the Brazilian Ministry of Health and the health secretary of Pernambuco state,1 and the differential diagnosis was based on clinical presentation, personal and family history, laboratory test results, and radiological findings.

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