Association between confirmed congenital Zika infection at birth and outcomes up to 3 years of life

Abstract

Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.

Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure

“…Like our cohort, most case series report a profound developmental delay in language, motor, and social domains (Alves, Paredes, Silva, Mello, & Alves, 2018). The structural and functional brain abnormalities found in children with congenital ZIKV infection, have been related to the severity of neurological and neurodevelopmental alterations (Hcini et al, 2021;Wheeler, 2018), and as expected, children with the most severe brain compromise (Pattern 1 in our cohort), tended to have poorer motor outcomes. To date, no publications have correlated 2D neuroimaging measurement patterns to motor or other developmental outcomes for children with congenital ZIKV infection, highlighting the importance of further studies in this area.…”

Congenital Zika Infection and the Risk of Neurodevelopmental, Neurological, and Urinary Track Disorders in Early Childhood. A Systematic Review

“…Furthermore, the exposed children had a greater risk for cognitive delay and abnormal auditory behavior. In a cohort study of Hcini (2021) [ 36 ], data from 129 cases of exposed Zika virus children were collected from a pediatric clinic of French Guiana. In the case of infected children, there was a greater risk of neurological outcomes, even when no brain abnormalities were observed.…”

Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018

“…However, there is inconsistency in the literature around the potential neurodevelopmental impacts of Zika virus infection in pregnancy among children without Zika-associated brain and eye defects. There is evidence of neurodevelopmental delay based on standardized assessments of cohorts of children in Brazil [22,[39][40][41], Colombia [11], Nicaragua [42], Mexico [43], and French Guiana [23] but in another Brazilian cohort, there was no evidence of cognitive, language or motor delay in 18-month-old children exposed to the Zika virus during pregnancy without Zika-associated birth defects [44].…”

“…A congenital Zika virus infection can cause microcephaly and severe birth defects of the brain and eye [4][5][6][7] and has been associated with neurodevelopmental abnormalities in the child, such as seizures, joint contractures, swallowing difficulties, vision impairments, hearing loss, and delayed achievement of developmental milestones [4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Most of these neurodevelopmental abnormalities have been observed in children with Zika-associated birth defects of the brain or eye, although there have been some neurodevelopmental abnormalities in children who are phenotypically unaffected at birth [11,22,23].…”