Early Gross Motor Development Among Brazilian Children with Microcephaly Born Right After Zika Virus Infection Outbreak

Abstract

Objective: To assess the gross motor development of children with presumed congenital Zika virus (ZIKV) infection over the first 2 years of their lives. Methods: Seventy-seven children were assessed at the median ages of 11, 18, and 24 months, using the evaluative instrument Gross Motor Function Measure (GMFM-66). At the third assessment, the children with diagnoses of cerebral palsy (CP) were classified by severity through the Gross Motor Function Classification System (GMFCS) and stratified by topography indicating the predominantly affected limbs. With these instruments in combination and using the motor development curves as reference, the rate of development and functional ability were estimated. Results: At 2 years of age, all children had the diagnosis of CP. Seventy-four (96.1%) presented gross motor skills similar to those of children aged 4 months or younger, according to the World Health Organization's standard. The GMFM-66 median score among the 73 (94.8%) children with quadriplegia and GMFCS level V showed significant change between 11 and 18 months (p < 0.001) and between 11 and 24 months (p < 0.001). No significant difference (p = 0.076) was found between 18 and 24 months. Conclusion: Despite showing some gross motor progress during the initial 18 months of life, these children with presumed congenital ZIKV infection and CP experienced severe motor impairment by 2 years of age. According to the motor development curves, these children with quadriplegia have probably already reached about 90% of their motor development potential.

Effects in the development of children exposed to zika virus in the fetal period: an integrative review

“…Thus, in ten studies (62.5%) was observed the presence of microcephaly; in seven (43.7%), ocular alterations such as nystagmus or visual impairment; in four (25%), ventriculomegaly; in three (18.7%), subcortical calcifications, alterations in fine motor development, arthrogryposis; in two (12.5%), cortical development malformation, cerebral atrophy, cerebral palsy with microcephaly, changes in motor and cognitive development and hearing loss; and in one (6.25%), convulsions, restless movements at 12 months without microcephaly, changes in sleep pattern, severe hypertonia and heart malformation (5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) .…”

“…Einspieler et al, (2019) (15) (16) To evaluate the gross motor development of children with supposedly congenital zika virus infection in the first two years of life.…”

Gross Motor Function in Children with Congenital Zika Syndrome

“…Another strength of the study is the fact that gross motor function was evaluated with the gold standard tools for CP evaluation, the GMFM-88 and GMFM-66, which are widely used in the literature due to their high validity, reliability, and sensitivity to changes, 26 in a larger sample than those evaluated in previous studies. 9,11,19,20 The 88 version has additional items and allows separate evaluation of the different dimensions, providing a detailed picture for younger and severely impaired children. 26 The GMFM-66, on the other hand, enables better comparison over time, among groups and with published for normative of CP children.…”

“…Data on follow-up on gross motor function in CZS children aged up to 3 years, as presented in this study, are scarce; the few studies available are generally restricted to the second year of life. 11,26 Children assessed in this study can be reevaluated in future studies, expanding the knowledge about motor function in children with CZS.…”

“…7 Therefore, laboratory testing has been integrated with clinical knowledge of CZS and presumed CZS is commonly diagnosed. [8][9][10][11] The motor function of children with probable CZS and cerebral palsy (CP) can be very compromised when compared with populations with typical development according to normative tests. [12][13][14] CZS children often present with CP 15,16 that differs from other congenital infections because of the following features: (1) severe microcephaly with partially collapsed skull; (2) thin cerebral cortices with subcortical calcifications;…”