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Grand Rounds

Can Infants Exposed Prenatally to Zika Have Abnormal Neurodevelopment in the Absence of Congenital Zika Syndrome?

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BACKGROUND AND PURPOSE:

  • Mulkey et al. (JAMA Pediatr., 2020) assessed whether infants without congenital Zika syndrome but who were exposed to Zika virus (ZIKV) in utero have normal neurodevelopmental outcomes

METHODS:

  • Longitudinal study of a prospective cohort
  • Participants
    • Pregnant women with ZIKV (Colombia)
    • Infants
      • Liveborn | Normal brain MRI and ultrasound | Normocephalic
      • No clinical evidence of congenital Zika syndrome
  • Exposure
    • Prenatal ZIKV exposure
  • Study design
    • At 1 or 2 time points between 4 and 18 months of age, infant development was assessed
      • Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA)
      • The Alberta Infant Motor Scale (AIMS)
    • The WIDEA and AIMS scores were converted using a Z-score and compared with normative samples
  • Primary outcome
    • Infant neurodevelopment until 18 months of age

RESULTS:

  • 70 infants were included
    • 57% evaluated between 4 and 8 months 
    • 86% evaluated between 9 and 18 months
  • There were curvilinear (ratio of change not constant) associations with age for the WIDEA
    • Total score (P < 0.003)
    • Self-care domain score (P < 0.008)
  • Other domain scores showed linear declines with age
    • Communication (P = 0.001)
    • Social cognition (P < 0.001)
    • Mobility (P < 0.001)
  • Differences were not see with the AIMS scores (P = 0.34)
  • 33% of children who underwent postnatal cranial ultrasonography had nonspecific, mild findings
    • AIMS Z-scores were lower in those infants with nonspecific cranial ultrasonography findings (P = 0.07)

CONCLUSION:

  • ZIKV-exposed infants, even in the absence of congenital Zika syndrome, were at higher risk for abnormal neurodevelopmental outcomes in the first 18 months of life
  • Long-term neurodevelopmental follow-up for ZIKV exposed infants is recommended

Learn More – Primary Sources:

Neurodevelopmental Abnormalities in Children With In Utero Zika Virus Exposure Without Congenital Zika Syndrome

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Related ObG Topics:

Zika Virus and Birth Defects: How Strong is the Correlation?
New CDC Interim Guidance on Infants with Possible Zika & Perinatal Review (Oct 2017)
Update on Zika Virus Infection and Adverse Pregnancy Outcome
Is Prenatal Ultrasound Sufficient to Identify Zika Virus Brain Defects?

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