Characteristics of children of the Microcephaly Epidemic Research Group Pediatric Cohort who developed postnatal microcephaly

Abstract

The number of studies published on postnatal microcephaly in children with Congenital Zika Syndrome is small, clinical presentations vary and aspects of the evolution of these children remain unclarified. The present case series examined clinical characteristics and assessed the growth velocity of the head circumference, weight and height Z-scores in 23 children who developed postnatal microcephaly during follow-up in the Microcephaly Epidemic Research Group Pediatric Cohort. To estimate the change in the head circumference, weight and height Z-scores over time and compare the mean difference between sexes, we used multilevel mixed-effects linear regressions with child-specific random effects. Among these children, 60.9% (n = 14/23) presented with craniofacial disproportion, 60.9% (n = 14/23) with strabismus, 47.8% (n = 11/23) with early onset seizures, 47.8% (n = 11/23) with dysphagia and 43.5% (n = 10/23) with arthrogryposis. Of the 82.7% (n = 19/23) children who underwent neuroimaging, 78.9% (n = 15/19) presented with alterations in the central nervous system. Monthly growth velocity, expressed in Z-scores, of the head circumference was − 0.098 (95% CI % − 0.117 to − 0.080), of weight was: − 0.010 (95%-CI − 0.033 to 0.014) and of height was: − 0.023 (95%-CI − 0.046 to 0.0001). Postnatal microcephaly occurred mainly in children who had already presented with signs of severe brain damage at birth; there was variability in weight and height development, with no set pattern.

Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil

“…Additionally, we found growth alterations in non-microcephalic children, an aspect not evidenced by Aguiar et al when assessing height. In a series of cases with 23 children exposed to the Zika virus who were born without microcephaly but who developed postnatal microcephaly and most of whom had neurological alterations, carried out in Pernambuco, Brazil, with children from the Pediatric Cohort of the Microcephaly Epidemic Research Group (MERG-PC), the monthly change in z-scores for length was –0.023 (95% CI −0.046 to 0.0001, p = 0.050), but their results for confidence intervals contain zero, so the data may indicate individual variations in opposite directions over time or that there was no change in the growth rate [ 55 ]. We showed statistically significant differences in GV between genders, with greater impairment of GV in females [ 33 , 56 ]; however, as distinctly described in the literature, boys, in general, tend to be more affected by height failures than girls in the first three to five years of life [ 29 , 34 , 44 , 57 ].…”

“…We showed statistically significant differences in GV between genders, with greater impairment of GV in females [ 33 , 56 ]; however, as distinctly described in the literature, boys, in general, tend to be more affected by height failures than girls in the first three to five years of life [ 29 , 34 , 44 , 57 ]. Ramos et al showed no statistical difference between sexes in the monthly change in z-scores for length; however, for girls as a whole, there was decrease in z-score over time, but also with individual variations during the follow-up period [ 55 ]. Children with GV reduction, but who still have normal height, should be investigated early, even before their height becomes evidently compromised [ 28 , 33 ].…”

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 .…”

“…Moreover, the neurological condition may lead to changes in the oral-motor system, further impacting its function. Various studies report the presence of dysphagia in children with microcephaly 9,[11][12][13][14] , affecting their motor development 12 , weight, and stature 14 .…”

Congenital Zika syndrome

“…Cranial alterations such as microcephaly and intracranial calcifications can be identified mainly at the end of the second and beginning of the third trimester 89 . On the other hand, images taken by CT or MRI can identify some of the findings that have been described in patients with CZS, such as intracranial calcifications, ventriculomegaly, increased extra-axial fluid, polymicrogyria (alterations of neuronal migrations resulting in excessive cortical folds and shallow sulci), reduction of brain parenchymal volume, cortical atrophy or malformation, hypoplasia of the cerebellum or cerebellar vermis, delayed myelination, and hypoplasia of the corpus callosum 40,[89][90][91] .…”