Early Predictors of Poor Neurologic Outcomes in a Prospective Cohort of Infants With Antenatal Exposure to Zika Virus.
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
entrez:
10
2
2022
pubmed:
11
2
2022
medline:
8
3
2022
Statut:
ppublish
Résumé
Identify early predictors of poor neurodevelopment in infants with antenatal Zika virus (ZIKV) exposure. Analysis of a prospective cohort of infants with antenatal ZIKV exposure confirmed by maternal or infant RT-PCR or IgM during the epidemic in Rio de Janeiro, Brazil. Clinical findings before 3 months of age were associated with Bayley-III Scales of Infant and Toddler Development conducted after 6 months of age. ZIKV exposure was confirmed in 219 cases; 162 infants were normocephalic, 53 were microcephalic, 4 had no head circumference recorded because of perinatal death/LTFU. Seven of the 112 normocephalic infants developed secondary microcephaly between 3 weeks and 8 months of age. Among the normocephalic at birth cohort, the mean HCZ among normal, at risk, and developmentally delayed children was significantly different (ANOVA, P = 0.02). In particular, the mean HCZ of the developmentally delayed group was significantly lower than that of the normal group (Tukey's test, P = 0.014). HCZ was more strongly associated with lower expressive language scores (P = 0.04) than receptive language scores (P = 0.06). The rate of auditory abnormalities differed among the normal, at risk, and developmentally delayed groups (Chi-squared test, P = 0.016), which was driven by the significant difference between the normal and at risk groups (post hoc test, P = 0.011, risk ratio 3.94). Auditory abnormalities were associated with both expressive and receptive language delays (P = 0.02 and P = 0.02, respectively). Clear predictors of neurodevelopment in normocephalic ZIKV-exposed children have not been previously identified. Our findings demonstrate that smaller HCZ and auditory abnormalities in these infants correlate with poor neurodevelopment as toddlers. Language delay is the most prominent developmental concern among these children, who will require frequent auditory and speech evaluations throughout childhood.
Sections du résumé
BACKGROUND
Identify early predictors of poor neurodevelopment in infants with antenatal Zika virus (ZIKV) exposure.
METHODS
Analysis of a prospective cohort of infants with antenatal ZIKV exposure confirmed by maternal or infant RT-PCR or IgM during the epidemic in Rio de Janeiro, Brazil. Clinical findings before 3 months of age were associated with Bayley-III Scales of Infant and Toddler Development conducted after 6 months of age.
RESULTS
ZIKV exposure was confirmed in 219 cases; 162 infants were normocephalic, 53 were microcephalic, 4 had no head circumference recorded because of perinatal death/LTFU. Seven of the 112 normocephalic infants developed secondary microcephaly between 3 weeks and 8 months of age. Among the normocephalic at birth cohort, the mean HCZ among normal, at risk, and developmentally delayed children was significantly different (ANOVA, P = 0.02). In particular, the mean HCZ of the developmentally delayed group was significantly lower than that of the normal group (Tukey's test, P = 0.014). HCZ was more strongly associated with lower expressive language scores (P = 0.04) than receptive language scores (P = 0.06). The rate of auditory abnormalities differed among the normal, at risk, and developmentally delayed groups (Chi-squared test, P = 0.016), which was driven by the significant difference between the normal and at risk groups (post hoc test, P = 0.011, risk ratio 3.94). Auditory abnormalities were associated with both expressive and receptive language delays (P = 0.02 and P = 0.02, respectively).
CONCLUSIONS
Clear predictors of neurodevelopment in normocephalic ZIKV-exposed children have not been previously identified. Our findings demonstrate that smaller HCZ and auditory abnormalities in these infants correlate with poor neurodevelopment as toddlers. Language delay is the most prominent developmental concern among these children, who will require frequent auditory and speech evaluations throughout childhood.
Identifiants
pubmed: 35144270
doi: 10.1097/INF.0000000000003379
pii: 00006454-202203000-00024
pmc: PMC8901197
mid: NIHMS1744050
doi:
Banques de données
ClinicalTrials.gov
['NCT03255369']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-262Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : P30 AI028697
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI140718
Pays : United States
Organisme : NIAID NIH HHS
ID : R21 AI129534
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Ikejezie J, Shapiro CN, Kim J, et al. Zika virus transmission - region of the Americas, May 15, 2015-December 15, 2016. MMWR Morb Mortal Wkly Rep. 2017;66:329–334.
Schuler-Faccini L, Ribeiro EM, Feitosa IM, et al.; Brazilian Medical Genetics Society–Zika Embryopathy Task Force. Possible association between Zika virus infection and microcephaly - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:59–62.
Hurtado-Villa P, Puerto AK, Victoria S, et al. Raised frequency of microcephaly related to Zika virus infection in two birth defects surveillance systems in Bogotá and Cali, Colombia. Pediatr Infect Dis J. 2017;36:1017–1019.
Rasmussen SA, Jamieson DJ, Honein MA, et al. Zika virus and birth defects–reviewing the evidence for causality. N Engl J Med. 2016;374:1981–1987.
Brasil P, Pereira JP Jr, Moreira ME, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med. 2016;375:2321–2334.
Saad T, PennaeCosta AA, de Góes FV, et al. Neurological manifestations of congenital Zika virus infection. Childs Nerv Syst. 2018;34:73–78.
Moura da Silva AA, Ganz JSS, da Silva Sousa P, et al. Early growth and neurologic outcomes of infants with probable congenital Zika virus syndrome. Emerg Infect Dis. 2016;22:1953–1956.
Madaschi V, Mecca TP, Macedo EC, et al. Bayley-III scales of infant and toddler development: transcultural adaptation and psychometric properties. Paidéia (Ribeirão Preto). 2016;26:189–197.
Lanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis. 2008;14:1232–1239.
Cranston JS, Tiene SF, Nielsen-Saines K, et al. Association between antenatal exposure to Zika virus and anatomical and neurodevelopmental abnormalities in children. JAMA Netw Open. 2020;3:e209303.
Villar J, Altman DG, Purwar M, et al.; International Fetal and Newborn Growth Consortium for the 21 st Century. The objectives, design and implementation of the INTERGROWTH-21 st Project. BJOG. 2013;120 Suppl 2:9–26, v.
de Onis M, Blössner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Int J Epidemiol. 2003;32:518–526.
Tsui I, Moreira MEL, Rossetto JD, et al. Eye findings in infants with suspected or confirmed antenatal Zika virus exposure. Pediatrics. 2018;142:e20181104.
Zin AA, Tsui I, Rossetto J, et al. Screening criteria for ophthalmic manifestations of congenital Zika virus infection. JAMA Pediatr. 2017;171:847–854.
Lopes Moreira ME, Nielsen-Saines K, Brasil P, et al. Neurodevelopment in infants exposed to Zika virus In Utero. N Engl J Med. 2018;379:2377–2379.
Nielsen-Saines K, Brasil P, Kerin T, et al. Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children. Nat Med. 2019;25:1213–1217.
Milne S, McDonald J, Comino EJ. The use of the Bayley Scales of Infant and Toddler Development III with clinical populations: a preliminary exploration. Phys Occup Ther Pediatr. 2012;32:24–33.
Del Rosario C, Slevin M, Molloy EJ, et al. How to use the Bayley scales of infant and Toddler development. Arch Dis Child Educ Pract Ed. 2021;106:108–112.
Vassar R, Schadl K, Cahill-Rowley K, et al. Neonatal brain microstructure and machine-learning-based prediction of early language development in children born very preterm. Pediatr Neurol. 2020;108:86–92.
Pool KL, Adachi K, Karnezis S, et al. Association between neonatal neuroimaging and clinical outcomes in Zika-exposed infants from Rio de Janeiro, Brazil. JAMA Netw Open. 2019;2:e198124.
Zar J. Biostatistical Analysis. 4th ed. Prentice Hall; 1999.
R Core Team. R: A Language and Environment for Statistical Computing . R Foundation for Statistical Computing; 2021. Available at: https://www.R-project.org/ . Accessed July 27, 2021.
Garcez PP, Loiola EC, Madeiro da Costa R, et al. Zika virus impairs growth in human neurospheres and brain organoids. Science. 2016;352:816–818.
Tang H, Hammack C, Ogden SC, et al. Zika virus infects human cortical neural progenitors and attenuates their growth. Cell Stem Cell. 2016;18:587–590.
Qian X, Nguyen HN, Song MM, et al. Brain-region-specific organoids using mini-bioreactors for modeling ZIKV exposure. Cell. 2016;165:1238–1254.
Driggers RW, Ho CY, Korhonen EM, et al. Zika virus infection with prolonged maternal viremia and fetal Brain abnormalities. N Engl J Med. 2016;374:2142–2151.
Parmar H, Ibrahim M. Pediatric intracranial infections. Neuroimaging Clin N Am. 2012;22:707–725.
Averill LW, Kandula VV, Akyol Y, et al. Fetal brain magnetic resonance imaging findings In congenital cytomegalovirus infection with postnatal imaging correlation. Semin Ultrasound CT MR. 2015;36:476–486.
Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2017;171:288–295.
van der Linden V, Filho EL, Lins OG, et al. Congenital Zika syndrome with arthrogryposis: retrospective case series study. BMJ. 2016;354:i3899.
Ventura CV, Maia M, Travassos SB, et al. Risk factors associated with the ophthalmoscopic findings identified in infants with presumed Zika virus congenital infection. JAMA Ophthalmol. 2016;134:912–918.
França GV, Schuler-Faccini L, Oliveira WK, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016;388:891–897.
Johansson MA, Mier-y-Teran-Romero L, Reefhuis J, et al. Zika and the risk of microcephaly. N Engl J Med. 2016;375:1–4.
Orofino DHG, Passos SRL, de Oliveira RVC, et al. Cardiac findings in infants with in utero exposure to Zika virus- a cross sectional study. PLoS Negl Trop Dis. 2018;12:e0006362.
Pedra CA, Haddad J, Pedra SF, et al. Paediatric and congenital heart disease in South America: an overview. Heart. 2009;95:1385–1392.