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Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort.
Sobral da Silva, Paula Fabiana; Eickmann, Sophie Helena; Arraes de Alencar Ximenes, Ricardo; Ramos Montarroyos, Ulisses; de Carvalho Lima, Marilia; Turchi Martelli, Celina M; Velho Barreto de Araújo, Thalia; Brickley, Elizabeth B; Cunha Rodrigues, Laura; Lima da Silva Pastich Gonçalves, Fabiana Cristina; Costa Gomes Carvalho, Maria Durce; Vieira de Souza, Wayner; de Barros Miranda-Filho, Demócrito.
Affiliation
  • Sobral da Silva PF; Hospital Universitário Oswaldo Cruz, Recife, Brasil. paulafsobral@yahoo.com.br.
  • Eickmann SH; Universidade Federal de Pernambuco, Recife, Brazil.
  • Arraes de Alencar Ximenes R; Hospital Universitário Oswaldo Cruz, Recife, Brasil.
  • Ramos Montarroyos U; Universidade Federal de Pernambuco, Recife, Brazil.
  • de Carvalho Lima M; Hospital Universitário Oswaldo Cruz, Recife, Brasil.
  • Turchi Martelli CM; Universidade Federal de Pernambuco, Recife, Brazil.
  • Velho Barreto de Araújo T; Instituto de Pesquisa Aggeu Magalhães, Recife, Brazil.
  • Brickley EB; Universidade Federal de Pernambuco, Recife, Brazil.
  • Cunha Rodrigues L; London School, London, England.
  • Lima da Silva Pastich Gonçalves FC; London School, London, England.
  • Costa Gomes Carvalho MD; Universidade Federal de Pernambuco, Recife, Brazil.
  • Vieira de Souza W; Hospital Universitário Oswaldo Cruz, Recife, Brasil.
  • de Barros Miranda-Filho D; Instituto de Pesquisa Aggeu Magalhães, Recife, Brazil.
BMC Pediatr ; 20(1): 472, 2020 10 10.
Article in En | MEDLINE | ID: mdl-33038931
BACKGROUND: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. METHODS: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. RESULTS: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were 'at risk of development delay' according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were 'at risk of development delay'. For children without microcephaly, the percentages found to be 'at risk of developmental delay' were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. CONCLUSIONS: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pregnancy Complications, Infectious / Epidemics / Zika Virus / Zika Virus Infection / Microcephaly Type of study: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Risk_factors_studies Limits: Child / Child, preschool / Female / Humans / Infant / Pregnancy Country/Region as subject: America do sul / Brasil Language: En Journal: BMC Pediatr Journal subject: PEDIATRIA Year: 2020 Document type: Article Affiliation country: Brazil Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pregnancy Complications, Infectious / Epidemics / Zika Virus / Zika Virus Infection / Microcephaly Type of study: Diagnostic_studies / Etiology_studies / Observational_studies / Prevalence_studies / Risk_factors_studies Limits: Child / Child, preschool / Female / Humans / Infant / Pregnancy Country/Region as subject: America do sul / Brasil Language: En Journal: BMC Pediatr Journal subject: PEDIATRIA Year: 2020 Document type: Article Affiliation country: Brazil Country of publication: United kingdom