Cardiac findings in infants with in utero exposure to Zika virus- a cross sectional study

Abstract

BackgroundAntenatal exposure to Zika virus (ZIKV) is related to severe neurological manifestations. A previous study in Brazil reported an increased incidence of non-severe congenital heart defects in infants with diagnosis of congenital Zika syndrome but without laboratory confirmation of ZIKV infection in the mother or infant. The objective of this study is to report echocardiographic (ECHO) findings in infants with laboratory confirmed antenatal exposure to ZIKV.MethodologyCross sectional study of cardiologic assessments of infants born between November 2015 and January 2017 with confirmed vertical exposure to ZIKV in Rio de Janeiro, Brazil.ResultsThe study enrolled 120 children with a median age of 97 days (1 to 376 days). In utero exposure to ZIKV was confirmed in 97 children (80,8%) through positive maternal polymerase chain reaction (PCR) results during pregnancy or a positive PCR result at birth; 23 additional children (19.2%) had maternal positive PCR results during pregnancy and postnatally. Forty- eight infants (40%) had cardiac defects noted on ECHO. Thirteen infants (10.8%) had major cardiac defects (atrial septal defect, ventricular septal defect, patent ductus arteriosus). None of the defects were severe. The frequency of major defects was higher in infants whose mothers had a rash in the 2nd trimester of pregnancy, or who had altered Central Nervous System (CNS) imaging postnatally or were preterm.ConclusionsInfants with in utero ZIKV exposure have a higher prevalence of major cardiac defects, however none were severe enough to require immediate intervention. For this reason, guidelines for performance of postnatal ECHO in this population should follow general newborn screening guidelines, which significantly reduces the burden of performing emergent fetal or neonatal ECHOs in a setting where resources are not available, such as most Brazilian municipalities.

Clinical aspects of congenital microcephaly syndrome by Zika virus in a rehabilitation center for patients with microcephaly

“…In our study, only one child with ZIKV microcephaly had cardiac abnormalities, a much lower frequency than in the study by Orofino et al 9 . However, this data suggests that the importance given to the research of cardiac comorbidities in patients with ZIKV should be lower than other comorbidities, such as neurological ones.…”

Teratogen update: Zika virus and pregnancy

“…This finding was important not only for the care of infants since rapid identification of this complication can lead to better medical care, but it also provided evidence of involvement of the peripheral nervous system in some infants with congenital Zika virus infection. At least two studies have reported an increased frequency of congenital heart defects among children with prenatal Zika virus exposure (Cavalcanti et al, 2017;Orofino et al, 2018). However, given that these defects have been mild in nature (e.g., secundum atrial and muscular ventricular septal defects), screening for these defects among Zika-exposed infants is not recommended.…”

#29 Heart rate variability monitoring identifies asymptomatic toddlers exposed to Zika virus during pregnancy

“…[6][7][8] Although ZIKV seems to be prominently neurotropic, there are some reports of involvement of other organs, particularly the heart. Cavalcanti 10 None of the defects were severe.…”