Evidence Matters

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

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

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

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)

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

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