Introduction: An increase in the prevalence of microcephaly was observed during the Zika virus pandemic, and there are currently data that reveal a high risk of adverse outcomes among the newborns. Studies report both neurological alterations and delayed neurodevelopment.Objective: To evaluate the impact of in-utero Zika virus infection on the neurodevelopment of children.Methods: Systematic review of observational studies on neurodevelopmental outcomes of in-utero Zika virus infection recorded in PROSPERO (CRD42021283963). The databases consulted were PubMed, Embase, SciELO and Scopus. The quality of the evidence was assessed according to the Joanna Briggs Institute guidelines.Results: 5180 records were obtained, of which 45 studies were included, all with low risk of bias. Children with congenital Zika infection and microcephaly have a severe global neurodevelopmental delay and most have minimal motor function, while children who do not present microcephaly during the different follow-up times may have some kind of developmental delay, mainly in the domain of language.Conclusion: In-utero exposure to Zika virus is associated with alterations in the neurodevelopment of children, with greater impact in those with microcephaly, and long-term follow-up should be effected in normocephalic children due to the risk of deterioration mainly in the area of language.