Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico

Alvarado-Domenech, Luisa I.; Rivera‐Amill, Vanessa; Appleton, Allison A.; Rosario-Villafañe, Viviana; Repollet-Carrer, Irelis; Borges-Rodríguez, Marilyn; Pérez-Rodríguez, Nicole M.; Olivieri-Ramos, Odette; González, Marielly; González-Montalvo, Carmen; Muñiz-Forestier, Wilmarie; Vargas-Lasalle, Luzeida; Pérez-Padilla, Janice; Paz-Bayley, Gabriela; Rodríguez-Rabassa, Mary

doi:10.1016/j.jpeds.2022.05.016

Cited by 8 publications

(11 citation statements)

References 40 publications

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“…The link of zika to congenital zika syndrome (CZS) and Guillain–Barre syndrome (GBS) has been established in the Caribbean, along with other intrauterine pregnancy complications, febrile illnesses, and unusual neurological complications in children (Figs. 2(a–e) and 3(a and b)) [40 ▪▪ ,41–50,51 ▪▪ ,52–54,55 ▪▪ ,56–65]. In French Guiana, maternofoetal transmission occurred in 26%; among ZIKV-positive foetuses/newborns, 20% had moderate signs, 21% had severe signs of CZS and 14% had foetal loss [44].…”

Section: Zikamentioning

confidence: 99%

“…Phylogenetic studies confirmed the arrival of the zika virus (ZIKV) in Jamaica, the Dominican Republic and Haiti, over 9 months before the formal identification of the first clinical case [ 39 , 40 ▪▪ ]. Zika has penetrated the Caribbean region (Table 1 ) [ 25 , 39 , 40 ▪▪ , 41 – 50 , 51 ▪▪ , 52 – 54 , 55 ▪▪ , 56 – 65 ]. The link of zika to congenital zika syndrome (CZS) and Guillain–Barre syndrome (GBS) has been established in the Caribbean, along with other intrauterine pregnancy complications, febrile illnesses, and unusual neurological complications in children (Figs.…”

Section: Zikamentioning

confidence: 99%

“…In Puerto Rico, lower receptive language scores at ages 3–12 months were documented in normocephalic infants with prenatal ZIKV exposure [ 53 ]. Another Puerto Rican study reported a cohort of ZIKV-exposed children, 97.4% of whom were normocephalic at birth, 17.5% failed age-appropriate vision screening and one-third had developmental delay, particularly in the language domain [ 55 ▪▪ ]. Also of concern is an increased prevalence of epilepsy documented in ZIKV-exposed infants in longitudinal Caribbean studies [ 54 , 56 ].…”

Section: Zikamentioning

confidence: 99%

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Dengue, chikungunya and zika arbovirus infections in Caribbean children

Christie

Lue²,

Melbourne-Chambers

2023

Current Opinion in Pediatrics

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Purpose of reviewDengue, chikungunya and zika have caused significant epidemics in the Caribbean in recent years. This review highlights their impact in Caribbean children.Recent findingsDengue has been increasingly intense and severe, seroprevalence is 80–100% in the Caribbean, children have increased attributable morbidity and mortality. Severe dengue, especially dengue with haemorrhage was significantly associated with haemoglobin SC disease and multiple organ-systems involved. These included the gastrointestinal and haematologic systems with extremely high lactate dehydrogenases and creatinine phosphokinases and severely abnormal bleeding indices. Despite appropriate interventions, mortality was highest within the first 48 h of admission. Chikungunya, a togavirus, affected 80% of some Caribbean populations. Paediatric presentations included high fever, skin, joint and neurological manifestations. Children less than 5 years of age had the highest morbidity and mortality. This maiden chikungunya epidemic was explosive and overwhelmed public health systems. Zika, another flavivirus, has a seroprevalence of 15% in pregnancy, so the Caribbean remains susceptible. Paediatric complications include pregnancy losses, stillbirths, Congenital Zika syndrome, Guillain–Barre syndrome, acute disseminated encephalomyelitis and transverse myelitis. Neurodevelopment stimulation programs for zika-exposed infants have been effective in improving language and positive behaviour scores.SummaryCaribbean children remain at risk for dengue, chikungunya and zika, with high attributable morbidity and mortality.

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Section: Zikamentioning

confidence: 99%

Section: Zikamentioning

confidence: 99%

Section: Zikamentioning

confidence: 99%

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Dengue, chikungunya and zika arbovirus infections in Caribbean children

Christie

Lue²,

Melbourne-Chambers

2023

Current Opinion in Pediatrics

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“…ZIKV infection is associated with a high rate of fetal loss (7–14%) encompassing mothers with asymptomatic as well as symptomatic infection [ 25 , 27 ]. Ventriculomegaly (33%), microcephaly (24%), intracranial calcifications (27%), ophthalmological anomalies and neurodevelopmental abnormalities are the most commonly described sequelae [ 28 , 29 , 30 ]. Adverse outcomes are more common with maternal infection in the first (55%) and second (52%) trimester but are also seen in the third trimester (29%) [ 25 ].…”

Section: Zika Virusmentioning

confidence: 99%

Arthropod-Borne Flaviviruses in Pregnancy

et al. 2023

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Flaviviruses are a diverse group of enveloped RNA viruses that cause significant clinical manifestations in the pregnancy and postpartum periods. This review highlights the epidemiology, pathophysiology, clinical features, diagnosis, and prevention of the key arthropod-borne flaviviruses of concern in pregnancy and the neonatal period—Zika, Dengue, Japanese encephalitis, West Nile, and Yellow fever viruses. Increased disease severity during pregnancy, risk of congenital malformations, and manifestations of postnatal infection vary widely amongst this virus family and may be quite marked. Laboratory confirmation of infection is complex, especially due to the reliance on serology for which flavivirus cross-reactivity challenges diagnostic specificity. As such, a thorough clinical history including relevant geographic exposures and prior vaccinations is paramount for accurate diagnosis. Novel vaccines are eagerly anticipated to ameliorate the impact of these flaviviruses, particularly neuroinvasive disease manifestations and congenital infection, with consideration of vaccine safety in pregnant women and children pivotal. Moving forward, the geographical spread of flaviviruses, as for other zoonoses, will be heavily influenced by climate change due to the potential expansion of vector and reservoir host habitats. Ongoing ‘One Health’ engagement across the human-animal-environment interface is critical to detect and responding to emergent flavivirus epidemics.

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“…Some infants with ZIKV exposure during pregnancy and no apparent symptomatology of CZS also have altered neurodevelopmental trajectories [19 ▪▪ ]. In a study of 111 children in Puerto Rico, USA exposed to maternal ZIKV infection without signs of CZS, 62% had at least one abnormal developmental domain on Bayley-III at 24 months, and 36% had one abnormal developmental domain at 36 months [73 ▪▪ ]. In a similar Brazilian study of 112 normocephalic infants with fetal ZIKV exposure assessed with Bayley-III between 6 months and 3 years, 36% had at least one abnormal developmental domain [74].…”

Section: Neurological and Developmental Outcomes Of Congenital Infect...mentioning

confidence: 99%

Neurodevelopmental outcomes in congenital and perinatal infections

Fortin

Mulkey

2023

Current Opinion in Infectious Diseases

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Purpose of review Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can cause severe neurodevelopmental impairment, cerebral palsy, epilepsy, and neurosensory impairments. New congenital infections and global viral pandemics have emerged, with some affecting the developing brain and causing neurodevelopmental concerns. This review aims to provide current understanding of fetal infections and their impact on neurodevelopment. Recent findings There are a growing list of congenital infections causing neurodevelopmental issues, including cytomegalovirus, Zika virus, syphilis, rubella, lymphocytic choriomeningitis virus, and toxoplasmosis. Fetal exposure to maternal SARS-CoV-2 may also pose risk to the developing brain and impact neurodevelopmental outcomes, although studies have conflicting results. As Zika virus was a recently identified congenital infection, there are several new reports on child neurodevelopment in the Caribbean and Central and South America. For many congenital infections, children with in-utero exposure, even if asymptomatic at birth, may have neurodevelopmental concerns manifest over time. Summary Congenital infections should be considered in the differential diagnosis of a child with neurodevelopmental impairments. Detailed pregnancy history, exposure risk, and testing should guide diagnosis and multidisciplinary evaluation. Children with congenital infections should have long-term follow-up to assess for neurodevelopmental delays and other neurosensory impairments. Children with confirmed delays or high-risk should be referred for rehabilitation therapies.

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Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico

Cited by 8 publications

References 40 publications

Dengue, chikungunya and zika arbovirus infections in Caribbean children

Dengue, chikungunya and zika arbovirus infections in Caribbean children

Arthropod-Borne Flaviviruses in Pregnancy

Neurodevelopmental outcomes in congenital and perinatal infections

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