In New York City, a greater proportion of women had probable Zika virus infection than confirmed infection. Women with some symptoms during pregnancy or periconceptionally were more likely to have a neonate with laboratory evidence of Zika virus infection. Neonates born to women with confirmed or probable Zika virus infection should be tested for Zika virus infection.
Background
Our goal was to characterize the epidemiology and clinical significance of congenital Zika virus (ZIKV) exposure by prospectively following a cohort of infants with possible congenital exposure through their first year of life.
Methods
We included infants born in New York City between 2016 and 2017 who had or were born to a woman who had laboratory evidence of ZIKV infection during pregnancy. We conducted provider/patient interviews and reviewed medical records to collect information about the pregnant women and, for infants, clinical and neurodevelopmental status at birth and 2, 6, and 12 months of age.
Results
Of the 404 infants who met inclusion criteria, most (385 [95.3%]) appeared well, whereas 19 (4.7%) had a possible ZIKV-associated birth defect. Seven had congenital ZIKV syndrome, and 12 were microcephalic without other abnormalities. Although infants with congenital ZIKV syndrome manifested clinical and neurodevelopmental sequelae during their first year of life, all 12 infants with isolated microcephaly were normocephalic and appeared well by 2 months of age. Laboratory evidence of ZIKV was detected for 22 of the infants, including 7 (31.8%) with a birth defect. Among 148 infants without a birth defect and negative/no laboratory results on ZIKV testing, and for whom information was available at 1 year, 4 presented with a developmental delay.
Conclusions
Among infants with possible congenital ZIKV exposure, a small proportion had possible ZIKV-associated findings at birth or at follow-up, or laboratory evidence of ZIKV. Identifying and monitoring infants with possible ZIKV exposure requires extensive efforts by providers and public health departments. Longitudinal studies using standardized clinical and developmental assessments are needed for infants after possible congenital ZIKV exposure.
Methods After training and attendance at the RCPCH Epilepsy Quality Improvement Programme (EQIP), a driver diagram, fishbone analysis, 5-whys methodology and patient questionnaire were used to understand the patient pathway. An EEG leaflet explaining the procedure is already sent to patients. However, it was noted that there was little information or avenue for families to ask questions or to allay fears and anxieties before attending. This highlighted the need for improved preparation in addition to the standard EEG leaflet before arrival to the hospital.A Model for Improvement with 4 PDSA (Plan, Do, Study, Act) cycles was employed to test change. Patient families were contacted several days before the EEG to discuss needs, anxieties and ways of working that might improve the experience and thereby the quality of the EEG recording eg room layout, staff in uniform, toys, Wifi availability etc.The later PDSA cycles highlighted logistical problems in telephoning all paediatric patients. Therefore, an addendum to the patient leaflet was sent to the patient. This signposted useful online material and other resources. Department photographs were also available on request. Results An improvement was seen in the number of quality EEGs recorded. The percentage of paediatric patients with full quality EEGs was seen to be consistently above 95% after introduction of the telephone call and leaflet addendum. No EEG recordings were abandoned. Very favourable feedback was gained from families about increased flexibility to tailor the EEG investigation. The Covid-19 pandemic unfortunately affected EEG wait times.This was a multidisciplinary quality improvement project resulting in rewarding, collaborative links to enable future dialogue and multidisciplinary working. Conclusions Quality of EEG recordings was improved by increased communication between families before appointment, either by discussion over the phone or
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