Alterations in deglutition in children with congenital Zika virus syndrome

Abstract

Purpose To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. Methods This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). Results The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. Conclusion Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.

Feeding development of children with microcephaly: a descriptive study

“…Feeding children with microcephaly is known to be potentially difficult from birth. In cases of microcephaly caused by congenital Zika virus infection, such changes seem to be particularly intensified after 3 months old, sometimes requiring an alternative feeding route or adaptations that enable oral feeding 10,13,14,17,20 .…”

“…Nonetheless, some specific conditions must be considered regarding babies with microcephaly, as they can interfere with their oral feeding performance. For instance, they may have abnormal lip tone, dystonic tongue movements, abnormal pharyngeal sensitivity, increased risk of bronchoaspiration, and severe dysphagia 3,10,16,17 . Studies also point out that dysphagia can manifest and/ or intensify after 3 months old, further justifying their early weaning 2,16 .…”

“…The integrity of the central nervous system is important to feeding functions. Therefore, children with neurological changes (such as microcephaly) may have oral function difficulties 4,10 . Moreover, the neurological condition may lead to changes in the oral-motor system, further impacting its function.…”

“…Since swallowing disorders can impair children's growth, development, and pulmonary health 2,10 , it is essential to address their nutritional care, especially in those more likely to have such difficulties -which is the case of microcephaly.…”

“…Some pieces of research have described dysphagia signs and symptoms 7,15,16 in 0-to-3-year-old children with microcephaly. However, few studies have addressed their food consistency 2,10,17 and the utensils used to feed them 17 .…”