Early Clinical Infancy Outcomes for Microcephaly and/or Small for Gestational Age Zika-Exposed Infants

Abstract

Background Zika-exposed infants with microcephaly (proportional or disproportional) and those who are small for gestational age without microcephaly should be closely followed, particularly their growth trajectories. They are at high risk of adverse outcomes in the first year of life. Antenatal Zika virus (ZIKV) exposure may lead to adverse infant outcomes including microcephaly and being small for gestational age (SGA). ZIKV-exposed infants with a diagnosis of microcephaly (proportional [PM] or disproportional [DM]) or SGA at birth were evaluated with anthropometric measurements and health outcomes. Methods Infants had laboratory-confirmed ZIKV exposure in Brazil. PM, DM, or SGA classification was based on head circumference and weight. First-year growth parameters and clinical outcomes were recorded with analyses performed. Results Among the 156 ZIKV-exposed infants, 14 (9.0%) were SGA, 13 (8.3%) PM, 13 (8.3%) DM, and 116 (74.4%) were neither SGA nor had microcephaly (NSNM). High rates of any neurologic, ophthalmologic, and hearing abnormalities were observed for PM (100%), DM (100%), and SGA (42.9%) vs NSNM infants (18.3%; P <.001); odds ratio [OR], 3.4 (95% confidence interval [CI], 1.1–10.7) for SGA vs NSNM. Neuroimaging abnormalities were seen in 100% of PM and DM and in 42.9% of SGA vs NSNM infants 16%; (P <.001); OR 3.9 (95% CI, 1.2–12.8) for SGA vs NSNM. Growth rates by z score, particularly for microcephaly infants, were poor after birth but showed improvement beyond 4 months of life. Conclusions ZIKV-exposed infants with microcephaly (PM and DM) had similarly high rates of adverse outcomes but showed improvement in growth measurements beyond 4 months of life. While SGA infants had fewer adverse outcomes compared with microcephaly infants, notable adverse outcomes were observed in some; their odds of having adverse outcomes were 3 to 4 times greater compared to NSNM infants. Zika-exposed infants with microcephaly, irrespective of being proportional or disproportional, and those who are small for gestational age without microcephaly should be closely followed, particularly their growth trajectories. They are at high risk of adverse outcomes in the first year of life.

Machine Learning-Driven and Smartphone-Based Fluorescence Detection for CRISPR Diagnostic of SARS-CoV-2

“…Nonetheless, our diagnostic system has proven to be sufficient for screening of infectious individuals as previous findings suggest minimal infectivity in patients with high Ct values and their low likelihood of viral transmission. 22 , 23 Moreover, the viral count is indicative of disease severity and infectivity of the infected individuals. Our system’s ability to report a quantitative value correlated with the viral load offers critical quantitative information that cannot be obtained from current readout methods, such as visual inspection or lateral flow strips.…”

Zika Virus Pathogenesis: From Early Case Reports to Epidemics

“…ZIKV-specific IgM has been detected in the CSF of neonates with fetal microcephaly, which is indicative of central nervous system (CNS) infection, and suggests that infection of the developing fetus may be required for fetal microcephaly to develop, not just infection of the mother [49]. Fetal microcephaly and other negative fetal outcomes are most closely linked with maternal ZIKV infection early in pregnancy (first trimester), with one study finding that the risk of below-average neurodevelopment fell by 46% each trimester (Figure 1) [16,50,51,52,53]. In a case-control study of factors associated with the development of CZS, no link was found with maternal age, previous dengue virus infection, or exposure to alcohol, drugs, or tobacco [50].…”

“…However, a separate study observed that women who gave birth to microcephalic infants had significantly higher serum neutralizing activity and antibodies reactive to the ZIKV envelope protein domain III, compared to control women [54]. Other birth defects linked to ZIKV infection include patent foramen ovale (failure of a natural hole between the left and right atria of the heart to close before birth), clubfoot, cryptorchidism (failure of the testes to descend into the scrotum), ophthalmologic problems, hearing abnormalities, and difficulty swallowing [16,50,51,52]. In some cases, fetal death following maternal ZIKV infection has also been reported [33,53].…”

“…The impact of ZIKV infection during pregnancy and on neonates is the most dramatic aspect of contemporary ZIKV outbreaks. Fetal microcephaly, which is typically diagnosed based on a head circumference at birth that is greater than two standard deviations below average for gestational age and sex, was first associated with ZIKV infection during the South and Central American outbreak [4,16]. Following this observation, retrospective analyses of the French Polynesian outbreak provided further evidence for an association between ZIKV infection during pregnancy and fetal microcephaly [17].…”

Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †

“…Although microcephaly is the most evident alteration of CZS, other anomalies resulting from congenital ZIKV infection have been described, even in the absence of this clinical sign [20]. This wide spectrum of clinical manifestations of microcephaly/CZS and its harmful consequences on the child's health and development, certainly increase vulnerability to childhood morbidity and mortality and may produce direct or indirect effects on their survival and development.…”