Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly

Abstract

Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015-2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report.

Orofacial features in children with microcephaly associated with Zika virus: A scoping review

“…The tongue's inadequate posture at rest is more frequent in more severe cases, as delays in dental eruption. The presence of narrow palatine vaults and alterations such as macroglossia and ankyloglossia should also be highlighted (Carvalho, Brites, et al., 2019; Carvalho, Alencar, et al., 2019; Cota et al., 2020; Fonteles et al., 2018; Gusmão et al., 2020; Oliveira, de Melo, et al., 2020; Oliveira, Miranda‐Filho, et al., 2020; Ribeiro et al., 2020).…”

Avaliação da função alimentar em crianças com microcefalia por Zika Vírus: acompanhamento de dois anos

“…anormalidades anatômicas e funcionais do sistema estomatognático em crianças com microcefalia relacionada ao Zika quando comparado aos controles (Oliveira et al, 2021).…”

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

“…Of note, the MERG pediatric cohort is one of the largest single cohort studies of children with CZS in the world. The MERG pediatric cohort study published several case series reporting on microcephaly [ 24 ], prenatal and postnatal brain imaging abnormalities [ 25 , 26 ], oropharyngeal dysphagia [ 27 ], early epilepsy [ 28 , 29 ] and rare complications such as cryptorchidism [ 30 , 31 ], endocrine dysfunctions [ 32 ], and adenoid hypertrophy [ 33 ] over the first years of life. Longer term follow-up of the prenatally exposed infants also found markedly elevated frequencies of seizures, ophthalmologic abnormalities, and hearing deficits in infants born with microcephaly or born small for gestational age relative to exposed infants born without microcephaly and normal or large for gestational age [ 34 ].…”