Neonatal Outcomes From Arboviruses in the Perinatal Period: A State-of-the-Art Review

Mimickers of Hypoxic Ischemic Encephalopathy

Although neonatal encephalopathy is most often caused by hypoxic-ischemic injury, there are many other causes. A careful history and clinical examination allow clinicians to identify neonates with these mimickers, so prompt intervention and support ensue to allow the best developmental outcome.

Growth and Survival of a Cohort of Congenital Zika Virus Syndrome Children Born With Microcephaly and Children Who Developed With Microcephaly After Birth

BACKGROUND AND OBJECTIVES

Little is known about the clinical course of children born with congenital Zika virus syndrome (CZS). This article aimed to analyze the growth and survival of children with CZS born with microcephaly and children who developed with microcephaly after birth in the 36-month period.

METHODS

This is a cohort of children diagnosed with CZS who were monitored in a series of outpatient appointments, with clinical and demographic information and anthropometric measurements collected. The Mann-Kendall test evaluated the trend of the mean Z-score of head circumference (HC) for age and the Kaplan-Meier model described the time to low weight and short length according to the classification of HC at birth.

RESULTS

Children born without microcephaly had a reduction in HC growth velocity ( P = 0.019) and took longer to reach low weight ( P = 0.036) and short length ( P = 0.034) when compared with those born with microcephaly. Seven (10%) deaths were reported, and the probability of survival after 36 months of age was 88%. In children with arthrogryposis, the risk of death was 7 times as high as in those without this condition (adjusted hazard ratio: 6.49; 95% confidence interval: 1.31-32.20; P = 0.022).

CONCLUSIONS

In this cohort of children with CZS, 20% were born without microcephaly and all of them presented a reduction in HC growth velocity, which led to microcephaly. Progression to low weight and short length occurred in the first years of life, and that was faster in those born with microcephaly. Healthcare providers should be aware of these conditions that pose a risk of unfavorable anthropometric measurements and death.

Maternal and Fetal Implications of Oropouche Fever, Espírito Santo State, Brazil, 2024

Reemergence of Oropouche fever in Brazil raises concerns about potential risks for infection in pregnancy. We describe a case series of Oropouche fever in pregnant women and their neonates in Espírito Santo State, Brazil, in 2024. Of 73 pregnancies, 15 pregnancies concluded by the end of the study period; of those, 14 resulted in live births and 1 in spontaneous abortion. Placental reverse transcription PCR tests were positive for Oropouche virus RNA in 5 infections in the third trimester. Two infections occurred in the first trimester, resulting in 1 spontaneous abortion and 1 live birth with corpus callosum dysgenesis. Of 13 infections that occurred in the third trimester, 1 showed possible intrapartum transmission with clinical manifestations in the neonate, whereas the others were asymptomatic. We found no anomalies in third-trimester infections. These findings suggest possible vertical transmission of Oropouche virus and a potential link with spontaneous abortion or malformation.

Developing brain under renewed attack: viral infection during pregnancy

Living in a globalized world, viral infections such as CHIKV, SARS-COV-2, and ZIKV have become inevitable to also infect the most vulnerable groups in our society. That poses a danger to these populations including pregnant women since the developing brain is sensitive to maternal stressors including viral infections. Upon maternal infection, the viruses can gain access to the fetus via the maternofetal barrier and even to the fetal brain during which factors such as viral receptor expression, time of infection, and the balance between antiviral immune responses and pro-viral mechanisms contribute to mother-to-fetus transmission and fetal infection. Both the direct pro-viral mechanisms and the resulting dysregulated immune response can cause multi-level impairment in the maternofetal and brain barriers and the developing brain itself leading to dysfunction or even loss of several cell populations. Thus, maternal viral infections can disturb brain development and even predispose to neurodevelopmental disorders. In this review, we discuss the potential contribution of maternal viral infections of three relevant relative recent players in the field: Zika, Chikungunya, and Severe Acute Respiratory Syndrome Coronavirus-2, to the impairment of brain development throughout the entire route.

Neonatal dengue: an under-diagnosed entity

Neonatal dengue is an under-diagnosed disease likely due to low index of suspicion along with its resemblance to sepsis. We hereby report two cases of neonatal dengue, highlighting the need of high degree of suspicion in infants born to febrile mothers even with maternal serology being negative. Moreover, severity of neonatal illness positively correlates with the maternal disease.