Neurodevelopment in the third year of life in children with antenatal ZIKV-exposure

Aizawa, Carolina Yuri Panvequio; Caron, Deyse Mayara Rodrigues; Souza, Carolina Barbosa de; Kozima, Paula Fernanda Augusto; Damasceno, Luana; Einspieler, Christa; Marschik, Peter B.; Brasil, Patrícia; Schmitt, Ana Carolina Basso; Nielsen‐Saines, Karin; Hasue, Renata Hydeé

doi:10.11606/s1518-8787.2021055002798

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…Although previous studies suggest that infants with in utero ZIKV exposure but without CZS are at risk of abnormal neurodevelopmental outcomes [ 43 , 44 , 45 ], our findings suggest that physical growth was not compromised in this group. Mean measures of weight, height and HC in the NCZS group of children were close to zero SD when compared to WHO standards, while CZS patients presented early and significant impairment in postnatal growth.…”

Section: Discussioncontrasting

confidence: 82%

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life

Aguiar

Pone

Gomes

et al. 2022

Viruses

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Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.

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Section: Discussioncontrasting

confidence: 82%

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life

Aguiar

Pone

Gomes

et al. 2022

Viruses

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“…Previous studies evaluating the neurodevelopmental outcome of normocephalic infants born to ZIKV exposed women found significant anomalies in neurodevelopment. However, these studies did not include an appropriate control group for comparison [ 12 – 15 , 30 – 32 ] or had a high risk of selection bias [ 33 – 36 ]. A study by Andrade et al [ 32 ] used a similar methodology to study exposed infants observing a higher rate of receptive language delay, but the absence of a control group limited the study; our study did not find any differences in receptive or expressive language between exposed and un exposed infants using the same Bayley III score.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women

et al. 2022

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An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration: www.clinicaltrials.gov, NCT02943304.

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“…There are several studies that have described abnormal neurodevelopmental effects in children prenatally exposed to ZIKV but not including a comparison group. (3,(5)(6)(7)(27)(28)(29)(30)(31)(32) At present, there are fewer studies regarding the effects of congenital ZIKV infection on the neurodevelopmental outcomes of children without apparent defects at birth. These studies implemented a variety of neurodevelopmental assessments or screeners used to evaluate the children and applied at different ages.…”

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confidence: 99%

Zika virus in Pregnancy in a Honduran cohort: neurodevelopmental assessment of normocephalic children born to Zika virus exposed and non-exposed pregnant people

Alger¹,

Cafferata

López³

et al. 2023

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Background Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results limited by the absence of a comparison group. The present study aimed to assess the neurodevelopmental outcomes among a cohort of children born with normal head circumference from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study between July and December 2016. Methods Enrollment of pregnant people was voluntary and occurred during their first prenatal visit at a health center in Tegucigalpa, with collection of venous blood. Children with the following characteristics were selected for the longitudinal follow-up study: normal birth head circumference, > 6 months of age, born at one of two hospitals in Tegucigalpa, and known in utero ZIKV exposure status. In utero exposure to ZIKV was defined as a positive prenatal ZIKV IgM and/or positive ZIKV RNA result at enrollment. The developmental evaluation included Spanish language versions of the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2). Results One hundred fifty-two children were assessed between May 2018 and March 2020. The mean age was 2.0 years, and > 93% had adequate anthropometric growth. Sixty children were exposed to ZIKV during pregnancy. BSID-III and ASQ:SE-2 were performed in 151 and 152 children, respectively. Forty-one children had a delay (< 85 composite score) in any of the BSID-III domains. There were no statistically significant differences between exposed and unexposed groups; however, children with in utero exposure to ZIKV had lower cognitive and language scores that persisted after adjusting for maternal age and education and after excluding children born preterm and low birth weight from the analysis. Assessment of socioemotional development showed that 92% of children had adequate development with a score equal to or below the cutoff point; there were no statistically significant differences between exposed and non-exposed children. Conclusions The exploration of cognitive and language differences in ZIKV exposed vs. non-exposed children could be informed by additional research in larger samples. Children with prenatal ZIKV exposure can be monitored for cognitive and language delays and referred for interventions as needed.

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Neurodevelopment in the third year of life in children with antenatal ZIKV-exposure

Cited by 7 publications

References 8 publications

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women

Zika virus in Pregnancy in a Honduran cohort: neurodevelopmental assessment of normocephalic children born to Zika virus exposed and non-exposed pregnant people

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