Would Zika virus Infection in Pregnancy Be a Sentence of Poor Neurological Prognosis for Exposed Children? Neurodevelopmental Outcomes in a Cohort from Brazilian Amazon

Abstract

Infections with Flavivirus in pregnant women are not associated with vertical transmission. However, in 2015, severe cases of congenital infection were reported during the Zika virus outbreak in Brazil. More subtle infections in children born to mothers with ZIKV still remain uncertain and the spectrum of this new congenital syndrome is still under construction. This study describes outcomes regarding neurodevelopment and neurological examination in the first years of life, of a cohort of 77 children born to pregnant women with ZIKV infection in Manaus, Brazil, from 2017 to 2020. In the group of normocephalic children (92.2%), most showed satisfactory performance in neuropsychomotor development, with a delay in 29.6% and changes in neurological examination in 27.1%, with two children showing muscle-strength deficits. All microcephalic children (5.2%) evolved with severe neuropsychomotor-development delay, spastic tetraparesis, and alterations in the imaging exam. In this cohort, 10.5% of the children had macrocephaly at birth, but only 2.6% remained in this classification. Although microcephaly has been considered as the main marker of congenital-Zika-virus syndrome in previous studies, its absence does not exclude the possibility of the syndrome. This highlights the importance of clinical follow-up, regardless of the classification of head circumference at birth.

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

“…Of the 77 children in the Abtibol-Bernardino [ 30 ] cohort, 71 were followed up regarding their anthropometric measurements and growth velocity. Of that group, 6 children were excluded because they attended a single assessment or went more than 12 months between assessments.…”

“…The high incidence of ZIKV in the period of 2015–2016 in Brazil may have significantly affected GV in children exposed to ZIKV. In this study, we describe the GV alterations of children exposed in utero to ZIKV when both mothers and children were followed up in a cohort in the Brazilian Amazon [ 21 , 30 ]. We showed that 24.2% of children had inadequate GV, and the frequency of inadequate GV was similar between microcephalic and non-microcephalic patients (approximately 24%), indicating the need for microcephalic and non-microcephalic patients to be evaluated constantly and without predilections.…”

“…Between March 2015 and August 2017, 77 women with laboratory-confirmed ZIKV infections during pregnancy and participants in the cohort of Redivo et al [ 21 ] and Abtibol-Bernardino et al [ 30 ] were invited to participate in the present study. Maternal ZIKV infection was confirmed in a blood or urine sample through real-time reverse transcriptase polymerase chain reaction (RT-PCR) detection.…”

“…Children born between March 2016 and June 2018 to mothers from the Redivo and Abtibol-Bernardino cohorts [ 21 , 30 ] were followed up at the outpatient clinic of the FMT-HVD, a tertiary reference center for tropical and infectious diseases in the state of Amazonas, for 42 months. At least two pediatric evaluations were performed during that follow-up period.…”

“…Anthropometry was analyzed (i) at birth and (ii) during follow-up based, respectively, on charts internationally standardized by INTERGROWTH-21 [ 38 , 39 ] and the WHO (WHO Anthro software), the latter being an instrument used to monitor growth in the population of children aged 0 to 60 months [ 40 ]. For cases of prematurity, the chronological age was corrected during the first two years of life in accordance with Babson [ 41 ]; neuropsychomotor developmental disorders (NPMD) were defined according to Abtibol-Bernardino [ 30 ].…”