Newborns with the characteristics of congenital syndrome associated with Zika virus (CSAZ) are being born in urban hospitals after the 2016 Zika virus epidemic in Jamaica. Phenotypic features include microcephaly, craniofacial disproportion, neuro-imaging and neuro-pathological findings and arthrogryposis. A trend towards babies being delivered with small head circumferences, but not yet in the range of microcephaly and others with normal head sizes who were born to women who were symptomatic in pregnancy is also being observed. While, most babies with probable CSAZ are being born to asymptomatic women who did not report any symptoms related to arbovirus illness in pregnancy. Diagnosis is challenged by serological cross-reactivity between circulating flaviviruses. Team management is multidisciplinary to maximize the neuro-developmental potential of this vulnerable patient population.