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Gama G, Conceição Matias MD, de Luiz Vânia M, de Sales Regis T, Peregrino-Filho A, de Sales Tavares J, Amorim M, Melo A. Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome. Physiother Theory Pract 2024; 40:1362-1371. [PMID: 36625893 DOI: 10.1080/09593985.2023.2165887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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Affiliation(s)
- Gabriela Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
| | | | - Mell de Luiz Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
| | | | | | | | - Melania Amorim
- Instituto de Pesquisa Professor Jpaquim Amorim Neto and Instituto de Medicina Integral Professor Fernando Figueira
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
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de Freitas DA, Wakimoto MD, Dias S, Souza-Santos R. High-Risk Areas for Congenital Zika Syndrome in Rio de Janeiro: Spatial Cluster Detection. Trop Med Infect Dis 2024; 9:105. [PMID: 38787038 PMCID: PMC11125739 DOI: 10.3390/tropicalmed9050105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Brazil reported 18,282 suspected congenital Zika syndrome (CZS) cases up to 2018 and accounts for 61.4% of the total reported Zika cases in the Americas in the period. To detect high-risk areas for children with CZS in the city of Rio de Janeiro, we used cluster detection and thematic maps. We analyzed data using a Poisson model in Satscan 10.1.3 software. We also analyzed the records of children with CZS from 2015 to 2016 to describe the clinical and epidemiological maternal and child profile, as well as live births in 2016 and the social development index (SDI) by neighborhood. In 2015 and 2016, the incidence rates of CZS were 8.84 and 46.96 per 100,000 live births in the city, respectively. Severe congenital findings such as microcephaly and brain damage, osteoarticular impairment, ocular abnormalities, and hearing loss were observed in 47 children. The spatial distribution of CZS was concentrated in the north and west zones in heterogeneous neighborhoods. The neighborhoods with the highest occurrence of CZS cases were found to have the worst SDIs. Stascan detected three spatial clusters in the north zone, where the SDI is lower. The clusters presented high relative risks for CZS (7.86, 1.46, and 2.08), although they were not statistically significant. Our findings highlight a higher occurrence of CZS in areas with less favorable socioeconomic conditions.
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Affiliation(s)
- Danielle Amaral de Freitas
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
| | - Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Rio de Janeiro 4365, RJ, Brazil;
| | - Sónia Dias
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), REAL, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560 Lisboa, Portugal;
| | - Reinaldo Souza-Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
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Oliveira DMDS, de Barros Miranda-Filho D, de Alencar Ximenes RA, Montarroyos UR, Brickley EB, Pinto MHT, Martelli CMT, Ramos RC, de Araújo TVB, Eickmann SH, da Silva PFS, Carvalho MDCG, de Sousa Martins OS, Dos Santos ACO. Feeding characteristics and growth among children with prenatal exposure to Zika virus with and without microcephaly in the microcephaly epidemic research group pediatric cohort. BMC Pediatr 2024; 24:286. [PMID: 38685089 PMCID: PMC11057065 DOI: 10.1186/s12887-024-04728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To describe the feeding characteristics and growth of children with prenatal exposure to Zika virus (ZIKV) from birth to 48 months. DESIGN Using data from the prospective Microcephaly Epidemic Research Group Pediatric Cohort (MERG-PC), children without microcephaly born to mothers with evidence of ZIKV infection during pregnancy (ZIKV-exposed children without microcephaly) and children with Zika-related microcephaly were compared using repeated cross-sectional analyses within the following age strata: birth; 1 to 12; 13 to 24; 25 to 36; and 37 to 48 months. The groups were compared in relation to prematurity, birth weight, breastfeeding, alternative feeding routes, dysphagia and anthropometric profiles based on the World Health Organization Anthro z-scores (weight-length/height, weight-age, length/height-age and BMI-age). RESULTS The first assessment included 248 children, 77 (31.05%) with microcephaly and 171 (68.95%) without microcephaly. The final assessment was performed on 86 children. Prematurity was 2.35 times higher and low birth weight was 3.49 times higher in children with microcephaly. The frequency of breastfeeding was high (> 80%) in both groups. On discharge from the maternity hospital, the frequency of children requiring alternative feeding route in both groups was less than 5%. After 12 months of age, children with microcephaly required alternative feeding route more often than children without microcephaly. In children with microcephaly, the z-score of all growth indicators was lower than in children without microcephaly. CONCLUSIONS Children with Zika-related microcephaly were more frequently premature and low birth weight and remained with nutritional parameters, i.e., weight-for-age, weight-for-length/height and length/height-for-age below those of the children without microcephaly.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Speech Terapist and Epidemiologist Universidade de Pernambuco Santo Amaro- Recife- Pernambuco, Street Arnóbio Marques, Recife, 31050100-130, Brazil.
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Lefton-Greif MA, Arvedson JC, Farneti D, Levy DS, Jadcherla SR. Global State of the Art and Science of Childhood Dysphagia: Similarities and Disparities in Burden. Dysphagia 2024:10.1007/s00455-024-10683-5. [PMID: 38503935 DOI: 10.1007/s00455-024-10683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
Feeding/swallowing and airway protection are complex functions, essential for survival, and continue to evolve throughout the lifetime. Medical and surgical advances across the globe have improved the long-term survival of medically complex children at the cost of increasing comorbidities, including dysfunctional swallowing (dysphagia). Dysphagia is prominent in children with histories of preterm birth, neurologic and neuromuscular diagnoses, developmental delays, and aerodigestive disorders; and is associated with medical, health, and neurodevelopmental problems; and long-term socioeconomic, caregiver, health system, and social burdens. Despite these survival and population trends, data on global prevalence of childhood dysphagia and associated burdens are limited, and practice variations are common. This article reviews current global population and resource-dependent influences on current trends for children with dysphagia, disparities in the availability and access to specialized multidisciplinary care, and potential impacts on burdens. A patient example will illustrate some questions to be considered and decision-making options in relation to age and development, availability and accessibility to resources, as well as diverse cultures and family values. Precise recognition of feeding/swallowing disorders and follow-up intervention are enhanced by awareness and knowledge of global disparities in resources. Initiatives are needed, which address geographic and economic barriers to providing optimal care to children with dysphagia.
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Affiliation(s)
- Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
- Departments of Pediatrics, Otolaryngology-Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Joan C Arvedson
- Department of Speech-Language Pathology, Children's Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniele Farneti
- Audiologic Phoniatric Service, ENT Department AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Deborah S Levy
- Department of Health and Human Communication, Universidade Federal, do Rio Grande do Sul, Brazil
- Department of Speech Pathology and Audiology, Hospital de Clínicas, de Porto Alegre, Brazil
- Multi-Professional Residency Program, Hospital de Clínicas, de Porto Alegre, Brazil
| | - Sudarshan R Jadcherla
- Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Silva LVDO, Arruda JAAD, Hashizume LN, Abreu MHNGD, Borges-Oliveira AC. Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study. Braz Oral Res 2024; 38:e020. [PMID: 38477806 DOI: 10.1590/1807-3107bor-2024.vol38.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/13/2023] [Indexed: 03/14/2024] Open
Abstract
The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.
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Affiliation(s)
- Leni Verônica de Oliveira Silva
- Universidade Federal de Minas Gerias - UFMG, School of Dentistry, Department of Oral Surgery, Pathology, and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - José Alcides Almeida de Arruda
- Universidade Federal de Minas Gerias - UFMG, School of Dentistry, Department of Oral Surgery, Pathology, and Clinical Dentistry, Belo Horizonte, MG, Brazil
| | - Lina Naomi Hashizume
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Social and Preventive Dentistry, Porto Alegre, RS, Brazil
| | | | - Ana Cristina Borges-Oliveira
- Universidade Federal de Minas Gerias - UFMG, School of Dentistry, Department of Social and Preventive Dentistry, Belo Horizonte, MG, Brazil
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Calado AM, Seixas F, Dos Anjos Pires M. Virus as Teratogenic Agents. Methods Mol Biol 2024; 2753:105-142. [PMID: 38285335 DOI: 10.1007/978-1-0716-3625-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Viral infectious diseases are important causes of reproductive disorders, as abortion, fetal mummification, embryonic mortality, stillbirth, and congenital abnormalities in animals and in humans. In this chapter, we provide an overview of some virus, as important agents in teratology.We begin by describing the Zika virus, whose infection in humans had a very significant impact in recent years and has been associated with major health problems worldwide. This virus is a teratogenic agent in humans and has been classified as a public health emergency of international concern (PHEIC).Then, some viruses associated with reproductive abnormalities on animals, which have a significant economic impact on livestock, are described, as bovine herpesvirus, bovine viral diarrhea virus, Schmallenberg virus, Akabane virus, and Aino virus.For all viruses mentioned in this chapter, the teratogenic effects and the congenital malformations associated with fetus and newborn are described, according to the most recent scientific publications.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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7
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Rodrigues CDS, Souza RKS, Rocha Neto CV, Otani RH, Batista DDM, Maia AKNDO, Filho KPDO, de Andrade TD, de Andrade Almeida E, Maciel LHG, Castro LDFAAP, Abtibol-Bernardino MR, Baia-da-Silva DC, Benzecry SG, Castilho MDC, Martínez-Espinosa FE, Alecrim MDGC, Santos RS, Botto-Menezes C. Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study. Viruses 2023; 15:2363. [PMID: 38140604 PMCID: PMC10747239 DOI: 10.3390/v15122363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.
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Affiliation(s)
- Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Cosmo Vieira Rocha Neto
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Rodrigo Haruo Otani
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Daniel de Medeiros Batista
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Ana Karla Nelson de Oliveira Maia
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | | | | | - Luiz Henrique Gonçalves Maciel
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas, Manaus 69020-160, Brazil
| | - Djane Clarys Baia-da-Silva
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Faculty of Pharmacy, University Nilton Lins, Manaus 69058-030, Brazil; (K.P.d.O.F.); (T.D.d.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Silvana Gomes Benzecry
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | - Flor Ernestina Martínez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders (PPGDIC), University of Tuiuti do Paraná (UTP), Paraná 82010-210, Brazil;
| | - Camila Botto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
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Díaz C, Aragón N, Lopez-Medina E, Arango MC, Dávalos D, Contreras-Rengifo A. Craniofacial and dental features in children aged 3-5 years with congenital Zika syndrome. Clin Oral Investig 2023; 27:5181-5188. [PMID: 37578656 PMCID: PMC10492677 DOI: 10.1007/s00784-023-05137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction, dysphagia among other previously described severe health complications. CZS is usually diagnosed postpartum by evident/apparent neural development problems. Although there are some reports of craniofacial/dentition development in CZS, several clinical oral aspects are still unknown. This study describes some structural and functional characteristics of facial and cranial growth and deciduous dentition in CZS-affected children. MATERIAL AND METHODS Some cranial, facial and dental characteristics were determined in 14 children with CZS aged 3-5 years and compared them against 12 apparently healthy children paired by age and gender. RESULTS Fourteen CZS cases presented microcephaly, maxillary prognathism, altered facial thirds, asymmetric pupillary line, bruxism (p = 0.006), deep and anterior open bite and distal step decidual molar relationship (p = 0.031). CZS children cannot feed by themselves and most cannot walk and have not develop coordinated and intelligible language according to their chronological age. In contrast, controls presented normal skull features, have autonomous locomotion skills, speak intelligible language, feed by themselves, presented a harmonic intermaxillary relationship and have symmetrical facial thirds. CONCLUSION Microcephaly, dysphagia, bruxism, mandibular retrognathia, altered facial proportions and malocclusion are the main craniofacial and oral features at CZS. CLINICAL RELEVANCE The complications of CZS including those related with the face and the oral cavity are still being identified. This study revealed some cranial, facial and oral features in children affected by CSZ. Interdisciplinary rehabilitation protocols must address these syndromic features that could improve children and parents living conditions.
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Affiliation(s)
- Catalina Díaz
- Advanced Program Pediatric Dentistry and Maxillary Orthopedics, Universidad del Valle, Cali, Colombia
- School of Dentistry, Universidad del Valle, Cali, Colombia
| | - Natalia Aragón
- School of Dentistry, Universidad del Valle, Cali, Colombia
- PhD Biomedical Sciences, Universidad del Valle, Cali, Colombia
- Periodontal Medicine Group, Universidad del Valle, Calle 3# 36 B 00 Building 132, Cali, Colombia
| | - Eduardo Lopez-Medina
- School of Medicine, Universidad del Valle, Cali, Colombia
- Center for Studies in Pediatric Infectology, CEIP, Cali, Colombia
- Quironsalud Group Clínica Imbanaco, Cali, Colombia
| | | | - Diana Dávalos
- Center for Studies in Pediatric Infectology, CEIP, Cali, Colombia
| | - Adolfo Contreras-Rengifo
- School of Dentistry, Universidad del Valle, Cali, Colombia
- Periodontal Medicine Group, Universidad del Valle, Calle 3# 36 B 00 Building 132, Cali, Colombia
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9
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Silva LVDO, Hermont AP, Magnani IQ, Martins CC, Borges-Oliveira AC. Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta-analyses. SPECIAL CARE IN DENTISTRY 2023; 43:184-198. [PMID: 35912588 DOI: 10.1111/scd.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
AIMS To synthesize the oral alterations observed in children with microcephaly associated with congenital Zika virus syndrome (CZS), and to compare the oral alterations of these children to a normotypic healthy controls. METHODS AND RESULTS A search was performed in six electronic databases. Observational studies published that reported oral alterations in children with CZS were selected. Two authors independently extracted data, assessed study quality, using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-one studies were included in this systematic review and meta-analysis. The pooled crude occurrence showed 88% of increased salivation (95%CI: 82%-94%), 83% of biofilm (95%CI: 75%-91%), and 73% of bruxism (95%CI: 52%-95%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 12.92; 95%CI: 3.42-48.78), with very low certainty. CONCLUSION There are several oral alterations found among children with CZS-associated microcephaly. They are more prone to present some of these alterations, such as difficulty in lip sealing, although with very low certainty of evidence.
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Affiliation(s)
- Leni Verônica de Oliveira Silva
- Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Paula Hermont
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabela Queiroz Magnani
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Borges-Oliveira
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Congenital Zika Syndrome and Disabilities of Feeding and Breastfeeding in Early Childhood: A Systematic Review. Viruses 2023; 15:v15030601. [PMID: 36992310 PMCID: PMC10052454 DOI: 10.3390/v15030601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
Background: The Zika virus outbreak has affected pregnant women and their infants. Affected infants develop microcephaly and other congenital malformations referred to as congenital Zika syndrome. The neurological manifestations of congenital Zika syndrome may result in some feeding disorders, including dysphagia, swallowing dysfunction and choking while feeding. The aim of this study was to assess the prevalence of feeding and breastfeeding difficulties in children with congenital Zika syndrome and to estimate the risk of developing feeding disabilities. Methods: We searched PubMed, Google Scholar and Scopus for studies published from 2017 to 2021. From the total of 360 papers, reviews, systematic reviews, meta-analyses and publications in languages other than English were excluded. Therefore, the final sample of our study consisted of 11 articles about the feeding/breastfeeding difficulties of infants and children with congenital Zika syndrome. Results: Infants and children with congenital Zika syndrome were likely to suffer from feeding difficulties at various levels, including breastfeeding. Dysphagia problems ranged from 17.9% to 70%, and nutritional and non-nutritive suckling of infants was also affected. Conclusions: In addition to continuing to investigate the neurodevelopment of affected children, future research should also focus on the severity of factors influencing the degree of dysphagia, as well as the impact of breastfeeding on the child’s overall development.
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11
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Costa MDCN, Cardim LL, Moore CA, de Jesus EDS, Carvalho-Sauer R, Barreto ML, Rodrigues LC, Smeeth L, Schuler-Faccini L, Brickley EB, Oliveira WK, Carmo EH, Pescarini JM, Andrade RFS, Rodrigues MMS, Veiga RV, Costa LC, França GVA, Teixeira MG, Paixão ES. Causes of death in children with congenital Zika syndrome in Brazil, 2015 to 2018: A nationwide record linkage study. PLoS Med 2023; 20:e1004181. [PMID: 36827251 PMCID: PMC9956022 DOI: 10.1371/journal.pmed.1004181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Children with congenital Zika syndrome (CZS) have severe damage to the peripheral and central nervous system (CNS), greatly increasing the risk of death. However, there is no information on the sequence of the underlying, intermediate, immediate, and contributing causes of deaths among these children. The aims of this study are describe the sequence of events leading to death of children with CZS up to 36 months of age and their probability of dying from a given cause, 2015 to 2018. METHODS AND FINDINGS In a population-based study, we linked administrative data on live births, deaths, and cases of children with CZS from the SINASC (Live Birth Information System), the SIM (Mortality Information System), and the RESP (Public Health Event Records), respectively. Confirmed and probable cases of CZS were those that met the criteria established by the Brazilian Ministry of Health. The information on causes of death was collected from death certificates (DCs) using the World Health Organization (WHO) DC template. We estimated proportional mortality (PM%) among children with CZS and among children with non-Zika CNS congenital anomalies (CA) by 36 months of age and proportional mortality ratio by cause (PMRc). A total of 403 children with confirmed and probable CZS who died up to 36 months of age were included in the study; 81.9% were younger than 12 months of age. Multiple congenital malformations not classified elsewhere, and septicemia unspecified, with 18 (PM = 4.5%) and 17 (PM = 4.2%) deaths, respectively, were the most attested underlying causes of death. Unspecified septicemia (29 deaths and PM = 11.2%) and newborn respiratory failure (40 deaths and PM = 12.1%) were, respectively, the predominant intermediate and immediate causes of death. Fetuses and newborns affected by the mother's infectious and parasitic diseases, unspecified cerebral palsy, and unspecified severe protein-caloric malnutrition were the underlying causes with the greatest probability of death in children with CZS (PMRc from 10.0 to 17.0) when compared to the group born with non-Zika CNS anomalies. Among the intermediate and immediate causes of death, pneumonitis due to food or vomiting and unspecified seizures (PMRc = 9.5, each) and unspecified bronchopneumonia (PMRc = 5.0) were notable. As contributing causes, fetus and newborn affected by the mother's infectious and parasitic diseases (PMRc = 7.3), unspecified cerebral palsy, and newborn seizures (PMRc = 4.5, each) were more likely to lead to death in children with CZS than in the comparison group. The main limitations of this study were the use of a secondary database without additional clinical information and potential misclassification of cases and controls. CONCLUSION The sequence of causes and circumstances involved in the deaths of the children with CZS highlights the greater vulnerability of these children to infectious and respiratory conditions compared to children with abnormalities of the CNS not related to Zika.
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Affiliation(s)
- Maria da Conceição N. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciana Lobato Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Cynthia A. Moore
- Goldbelt Professional Services, LLC, Chesapeake, Virginia, United States of America
| | - Eliene dos Santos de Jesus
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- Municipal Health Department, Department of Health Information, Salvador, Bahia, Brazil
| | - Rita Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- East Regional Health Center, State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia, Brazil
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lavínia Schuler-Faccini
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Wanderson K. Oliveira
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília, Distrito Federal, Brazil
| | - Eduardo Hage Carmo
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Julia Moreira Pescarini
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Physics Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Moreno M. S. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael V. Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Larissa C. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Maria Gloria Teixeira
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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12
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Rios D, Rios M, Nóbrega AC, Oliveira LBD, Vaz D, Sales H, Almeida BLD, Lopes LS, Siqueira ICD, Lucena R. Alterations in deglutition in children with congenital Zika virus syndrome. Codas 2023; 35:e20210270. [PMID: 36629551 PMCID: PMC10010433 DOI: 10.1590/2317-1782/20212021270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/23/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To characterize swallowing in children with congenital Zika virus syndrome in comparison to typical children. METHODS This cross-sectional study enrolled 45 children diagnosed with congenital Zika virus syndrome and 45 others with typical development. Swallowing was evaluated through clinical feeding evaluations Protocolo de Avaliação Clínica da Disfagia Pediátrica and using acoustic swallowing parameters (Doppler sonar). RESULTS The mean age of children with congenital Zika virus syndrome was 26.69 ± 4.46 months and the mean head circumference was 29.20 ± 1.98 cm. Moderate/severe oropharyngeal dysphagia was found in 32(71.1%) of the children with congenital Zika virus syndrome. Significant differences were found between the groups on clinical evaluation: Children with congenital Zika virus syndrome presented insufficient lip closure 42(93.3%) and altered tonus of the tongue 35(77.8%) and cheeks 34(75.6%). In the children in the comparison group, only 6(13.3%) presented insufficient lip closure and 1(2.2%) had inadequate tongue posture. Changes during swallowing with liquid and spoonable food were not observed in the comparison group. When liquid/food was offered, affected children presented difficulties in sipping movements 14(77.8%) and lip/spoon contact 35(75%). The presence of residual food in the oral cavity after swallowing 38(86.4%) and clinical signs indicative of laryngotracheal penetration/aspiration, such as coughing, gagging and/or labored breathing, were also notable. No differences were found between the groups with regard to the acoustic parameters evaluated instrumentally. CONCLUSION Children with congenital Zika virus syndrome present alterations in the oral phase of swallowing, as well as clinical signs indicative of pharyngeal phase impairment.
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Affiliation(s)
- Débora Rios
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Mino Rios
- Departamento de Psicologia, Universidade do Estado da Bahia - UNEB - Salvador (BA), Brasil
| | - Ana Caline Nóbrega
- Departamento de Fonoaudiologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | | | - Daniel Vaz
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Henrique Sales
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | | | - Leticia Serra Lopes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz - Fiocruz Salvador, (BA), Brasil
| | | | - Rita Lucena
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
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13
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de Paula GL, da Silva GAP, E Silva EJDC, Lins MDGM, Martins OSDS, Oliveira DMDS, Ferreira EDS, Antunes MMDC. Vomiting and Gastric Motility in Early Brain Damaged Children With Congenital Zika Syndrome. J Pediatr Gastroenterol Nutr 2022; 75:159-165. [PMID: 35653500 DOI: 10.1097/mpg.0000000000003504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES This study investigated the occurrence of vomiting and gastric dysmotility in dysphagic children with congenital Zika syndrome (CZS) and assessed possible associations of these findings with the severity of dysphagia and the presence of tube feeding. METHODS Forty-six children with CZS were assessed for dysphagia, and the occurrence of vomiting, dietary volume tolerance <15 mL/kg, and feeding time per meal >30 minutes were evaluated. Gastric antrum ultrasonography was used to detect the frequency of contractions and measure antral areas (at fasting and 15 minutes postprandial), from which the gastric emptying rate (GER) was calculated. Antral ultrasonography findings were compared with those of ten healthy controls. Vomiting and gastric motility were compared between CZS patients according to the severity of dysphagia and the requirement for tube feeding. RESULTS Overall, 76% (35/46) of children with CZS had moderate-to-severe dysphagia (MSD), among whom 60% (21/35) were tube fed [MSD tube fed (MSDTF)]. Vomiting occurred in 54% (25/46) of children, whereas dietary volume intolerance and prolonged feeding time were observed in 59% (27/46) and 37% (17/46), respectively, most frequently in MSDTF patients. On ultrasound, 61% (28/46) of children with CZS had no antral contractions, whereas 90% (9/10) of controls did. Compared to healthy controls, GER was eight-fold lower in children with CZS and 60-fold lower in MSDTF children. CONCLUSIONS In dysphagic children with CZS, vomiting, volume intolerance, and prolonged feeding time were frequent and possibly associated with impaired antral contraction and delayed gastric emptying, especially in cases of severe dysphagia and tube feeding.
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Affiliation(s)
- Georgia Lima de Paula
- From the Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- the Universidade de Pernambuco (UPE), Recife, PE, Brazil
- the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | | | - Eduardo Just da Costa E Silva
- From the Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
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14
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Abramov DM, Loureiro CBP, Abramov AK, Salles TRS, Moreira MEL, Lazarev VV. Mismatch Negativity is associated with affective social behavior in microcephaly. Int J Psychophysiol 2022; 180:10-16. [PMID: 35868544 DOI: 10.1016/j.ijpsycho.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/02/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022]
Abstract
Some children with severe microcephaly related to Zika virus infection show affective social-like behavior, such as smiling and rejection to a stranger's lap. Our objective was to check the association between this behavior and the occurrence of Mismatch Response (MMR) in event-related potentials. Twenty eight microcephalic children, aged 1-3 years, were divided in Affect(+) and Affect(-) groups, according to either the presence or absence of affective social-like behavior, respectively, and underwent the OddBall paradigm with vowels as auditory stimuli. MMR was statistically estimated comparing MMR sample means between both groups. The Affect(+) group significantly differed from the Affect(-) group and, as opposed to the latter, showed MMR as Mismatch Negativity (MMN) in the left occipital, left and right posterior temporal, and (especially) the right and median parietal leads. The relationship observed between MMN and affective social-like behavior suggests that these children may have cognitive mechanisms capable of providing some social interaction, despite their profound neurological dysfunction. MMN diagnostic techniques seem to be promising for the triage of microcephalic subjects regarding cognitive functions and for choosing a strategy for some social adaptation.
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Affiliation(s)
- Dimitri Marques Abramov
- Laboratory of Neurobiology and Clinical Neurophysiology, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Caroline Barros Pacheco Loureiro
- Laboratory of Neurobiology and Clinical Neurophysiology, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Amanda Kamil Abramov
- Laboratory of Neurobiology and Clinical Neurophysiology, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Tania Regina Saad Salles
- Laboratory of Neurobiology and Clinical Neurophysiology, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Elizabeth Lopes Moreira
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Vladimir V Lazarev
- Laboratory of Neurobiology and Clinical Neurophysiology, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
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15
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van der Linden H, Pessoa A, van der Linden A, Florêncio RN, Carvalho MDCG, van der Linden V. Epilepsy and EEG Abnormalities in Congenital Zika Syndrome. J Clin Neurophysiol 2022; 39:248-252. [PMID: 34999638 DOI: 10.1097/wnp.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY The congenital Zika syndrome is a new entity of a group of etiologies that can lead to microcephaly and other brain damages during pregnancy, such as toxoplasmosis, rubeola, cytomegalovirus, and herpes simplex. The Zika virus crosses the placental barrier and, predominantly, affects neuronal progenitor cells. This disruptive process results in severe cortical developmental disorder, calcifications, cortical and subcortical atrophies, and malformations of the cerebellum, brain stem, and spinal cord. Children with congenital Zika syndrome have a set of clinical findings, such as cerebral palsy, dysphagia, orthopedic deformities, visual and auditory impairment, and, rarely, hydrocephalus. Because of the severity of brain lesions, epilepsy is a common finding and a frequent cause of increased morbidity. The prevalence of epilepsy in different series of patients ranges from 37.7% to 71.4%. The aim of this study is to review the studies published so far regarding epilepsy and the EEG pattern in series of patients with congenital Zika syndrome.
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Affiliation(s)
- Hélio van der Linden
- Rehabilitation Center Dr. Henrique Santillo, Goiânia, Brazil
- Neurology Institute of Goiânia, Goiânia, Brazil
| | - André Pessoa
- Children's Hospital Albert Sabin, Fortaleza Brazil
- Ceará State University, Fortaleza, Brazil
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16
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de Aguiar EB, Pone SM, Gomes Junior SCDS, Soares FVM, Zin AA, Vasconcelos ZFM, Ribeiro CTM, Pereira Junior JP, Moreira MEL, Nielsen-Saines K, Pone MVDS. Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life. Viruses 2022; 14:v14050876. [PMID: 35632618 PMCID: PMC9147871 DOI: 10.3390/v14050876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022] Open
Abstract
Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.
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Affiliation(s)
- Elisa Barroso de Aguiar
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
- Correspondence: ; Tel.: +55-21-99584-9013
| | - Sheila Moura Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Saint Clair dos Santos Gomes Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Fernanda Valente Mendes Soares
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Andrea Araujo Zin
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Zilton Farias Meira Vasconcelos
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Carla Trevisan Martins Ribeiro
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - José Paulo Pereira Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Maria Elisabeth Lopes Moreira
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Vinicius da Silva Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Cavalcanti AFC, Arruda TDD, Aguiar YPC, Melo ASDO, Leal JIBDF, Sakly EH, Goncharuk-Khomyn M, Cavalcanti SDLB, Cavalcanti AL. Systemic Manifestations, Tooth Eruption and Enamel Defects in Children with Congenital Zika Virus Syndrome: 36-Month Follow-up Case Series. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Daza M, Mercado M, Moore CA, Valencia D, Lengua MF, Newton S, Rodríguez B, Tong VT, Acevedo P, Gilboa SM, Ospina ML, Mulkey SB. Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure. Birth Defects Res 2021; 113:1299-1312. [PMID: 34491004 PMCID: PMC10535366 DOI: 10.1002/bdr2.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Our aim was to describe the neuroimaging and clinical evaluations of children with antenatal Zika-virus (ZIKV) exposure. METHODS The Colombian National Institute of Health performed serial clinical evaluations of children with probable antenatal ZIKV exposure (i.e., born to ZIKV symptomatic mothers or born with birth defects compatible with ZIKV infection, regardless of laboratory results) over 2 years that included head circumference (HC), eye examination, and neurodevelopmental assessments. Clinical neuroimaging studies (head computed tomography and/or brain magnetic resonance imaging) were analyzed for abnormalities, two-dimensional measurements were made of the right and left frontal and occipital cortical thickness. Two abnormal patterns were defined: Pattern 1 (sum of four areas of cortex <6 cm) and Pattern 2 (sum of four areas of cortex ≥6 cm and < 10 cm). RESULTS Thirty-one children had a neuroimaging study; in 24, cortical thickness was measured. The median age at the first visit was 8 (range: 6-9) months and 22 (range: 19-42) months at the last evaluation. In the 24 cases with cortical measurements, three were normal, 12 were in Pattern 1, and nine were in Pattern 2. Children within Pattern 1 had lower mean HC at birth and in follow-up (both p < .05) and a higher frequency of structural eye abnormalities (p < .01). A trend towards poorer neuromotor development was seen in Pattern 1, although not statistically significant (p = .06). CONCLUSION Brain imaging classification based on cortical measurements correlate with ophthalmologic abnormalities and HC. Cortical thickness may be a marker for clinical outcomes in children with congenital ZIKV infection.
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Affiliation(s)
- Marcela Daza
- Research Division, Vysnova Partners, Bethesda, MD, United States
| | - Marcela Mercado
- Division of Research in Public Health, National Institute of Health of Colombia, Bogota, Colombia
| | - Cynthia A. Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Diana Valencia
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Suzanne Newton
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Blanca Rodríguez
- Division of Health Sciences, School of Medicine. Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Van T. Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pedro Acevedo
- Colombian Society of Pediatric Ophthalmology and Strabismus, Bogotá D.C, Colombia
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Martha L. Ospina
- General Director, National Institute of Health, Bogota D.C., Colombia
| | - Sarah B. Mulkey
- Prenatal Pediatrics Institute, Childreńs National Hospital, Washington, DC, United States
- Departments of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Departments of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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20
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Sato JR, Junior CEB, de Araújo ELM, de Souza Rodrigues J, Andrade SM. A guide for the use of fNIRS in microcephaly associated to congenital Zika virus infection. Sci Rep 2021; 11:19270. [PMID: 34588470 PMCID: PMC8481532 DOI: 10.1038/s41598-021-97450-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Congenital Zika Syndrome (CZS) is characterized by changes in cranial morphology associated with heterogeneous neurological manifestations and cognitive and behavioral impairments. In this syndrome, longitudinal neuroimaging could help clinicians to predict developmental trajectories of children and tailor treatment plans accordingly. However, regularly acquiring magnetic resonance imaging (MRI) has several shortcomings besides cost, particularly those associated with childrens' clinical presentation as sensitivity to environmental stimuli. The indirect monitoring of local neural activity by non-invasive functional near-infrared spectroscopy (fNIRS) technique can be a useful alternative for longitudinally accessing the brain function in children with CZS. In order to provide a common framework for advancing longitudinal neuroimaging assessment, we propose a principled guideline for fNIRS acquisition and analyses in children with neurodevelopmental disorders. Based on our experience on collecting fNIRS data in children with CZS we emphasize the methodological challenges, such as clinical characteristics of the sample, desensitization, movement artifacts and environment control, as well as suggestions for tackling such challenges. Finally, metrics based on fNIRS can be associated with established clinical metrics, thereby opening possibilities for exploring this tool as a long-term predictor when assessing the effectiveness of treatments aimed at children with severe neurodevelopmental disorders.
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Affiliation(s)
- João Ricardo Sato
- Center of Mathematics, Computing, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Claudinei Eduardo Biazoli Junior
- Center of Mathematics, Computing, and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Elidianne Layanne Medeiros de Araújo
- Laboratory of Aging and Neuroscience Studies, Department of Physical Therapy, Health Sciences Center, Federal University of Paraíba, João Pessoa, PA, Brazil
| | | | - Suellen Marinho Andrade
- Laboratory of Aging and Neuroscience Studies, Department of Physical Therapy, Health Sciences Center, Federal University of Paraíba, João Pessoa, PA, Brazil.
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21
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García-Boyano M, García-Segovia R, Fernández-Menéndez A, Pérez Y, Bustamante-Amador J, Layana-Coronel M, Caballero-Caballero JM, Rodríguez-Izquierdo C, Chávez-Solórzano N, Solís-Montiel D, Miño-León G. Long-Term Outcomes of Infants with Congenital Zika Virus Infection in Ecuador: A Retrospective Longitudinal Study. J Trop Pediatr 2021; 67:5912243. [PMID: 32984903 DOI: 10.1093/tropej/fmaa066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019. METHODS We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children's Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection. RESULTS Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort. CONCLUSIONS Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.
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Affiliation(s)
- Miguel García-Boyano
- Pediatric Infectious Disease Department, La Paz University Hospital, Madrid, Spain
| | - Roberto García-Segovia
- Pediatric Neurology Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
| | | | - Yamila Pérez
- Pediatric Neurology Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
| | | | - Marianella Layana-Coronel
- Pediatric Infectious Disease Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
| | | | | | - Nelly Chávez-Solórzano
- Pediatric Infectious Disease Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
| | - Dalton Solís-Montiel
- Pediatric Infectious Disease Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
| | - Greta Miño-León
- Pediatric Infectious Disease Department, Francisco Icaza Bustamante Children's Hospital, Guayaquil, Ecuador
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22
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Tavares JDS, Gama GL, Dias Borges MC, de Sousa Santos AC, Tavares JDS, Amorim MMR, Melo A. Classification of Congenital Zika Syndrome: Muscle Tone, Motor Type, Body Segments Affected, and Gross Motor Function. Dev Neurorehabil 2021; 24:296-302. [PMID: 33393410 DOI: 10.1080/17518423.2020.1866706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim: To identify abnormalities in muscle tone and motor function associated with congenital Zika syndrome (CZS).Method: A cross-sectional observational study involving 96 children (55 males) with CZS at a mean (SD) age 35.2 ± 2.9 months. Children's muscle tone was investigated using the pull to sit, scarf sign, shoulder suspension and ventral suspension tests and the modified Ashworth scale (MAS). Motor impairment was determined using the Gross Motor Function Classification System (GMFCS) and body segments most affected with motor impairment.Results: 58 (60,5%) children tested positive for ≥1 maneuver used to evaluate muscle tone, while 38 (39.5%) tested negative in all the tests. MAS score was >0 for at least one of the appendicular muscles in 91 children (94.8%). In 88 children (91.7%), all four limbs were affected.Conclusion: Findings suggestive of axial hypotonia and appendicular hypertonia associated with severe motor impairment were prevalent in children with CZS.
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Affiliation(s)
| | - Gabriela Lopes Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA University Center, Campina Grande, Paraíba, Brazil
| | | | | | | | | | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA University Center, Campina Grande, Paraíba, Brazil
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23
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Ribeiro RA, Mattos A, Meneghim MDC, Vedovello SAS, Borges TMD, Santamaria M. Oral and maxillofacial outcomes in children with microcephaly associated with the congenital Zika syndrome. Eur J Orthod 2021; 43:346-352. [PMID: 32524144 DOI: 10.1093/ejo/cjaa036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The objective of this study is to assess the oral and maxillofacial characteristics of microcephalic children associated with congenital Zika syndrome (CZS). METHODS A cross-sectional, observational study was carried out with 61 patients with microcephaly/CZS born between June 2015 and September 2017 (29 boys and 32 girls, average age of 22.8 months) and a control group with 58 non-CZS children born in the same period (25 boys and 33 girls, average age of 23.8 months). The functional clinical analysis considered the labial and lingual frena, tongue anterior projection, oral escape, palate form, and first tooth eruption. For the craniofacial analysis, facial anthropometric points and the cephalic perimeter at the time were measured. Demographic data were collected from medical records, and a clinical exam was performed in order to register the intrabuccal characteristics and craniofacial measures. The chi-square test and Student's t-test were used with a significance level of 0.05. RESULTS The narrow palate form, tongue anterior projection, oral escape, and late first tooth eruption were significantly more present in the group with microcephaly/CZS. As for the craniofacial analysis, face width (Bi-Zi), mandible width (Go-Go), height of face upper third (Tr-G), and monthly growth of cephalic perimeter were significantly smaller, whereas height of face lower third (Sn-Gn) was significantly bigger in the group with microcephaly/CZS (P < 0.05). CONCLUSION Children with microcephaly resulting from a congenital Zika infection showed functional, oral, and maxillofacial changes and smaller facial development in comparison with non-CZS children in the same age group.
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Affiliation(s)
- Renato Araújo Ribeiro
- Graduate Program in Orthodontics, College of Dentistry, Hermínio Ometto Foundation-FHO, Araras, SP, Brazil
| | - Adriana Mattos
- Hospital Geral Roberto Santos, Bahia State Department of Health, Salvador, BA, Brazil
| | - Marcelo de C Meneghim
- Department of Community Dentistry, Piracicaba Dental School, FOP-UNICAMP, SP, Brazil
| | - Silvia A S Vedovello
- Graduate Program in Orthodontics, College of Dentistry, Hermínio Ometto Foundation-FHO, Araras, SP, Brazil
| | | | - Milton Santamaria
- Graduate Program in Orthodontics, College of Dentistry, Hermínio Ometto Foundation-FHO, Araras, SP, Brazil.,Graduate Program in Biomedical Sciences, Hermínio Ometto Foundation-FHO, Araras, SP, Brazil
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24
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Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus. Viruses 2021; 13:v13030523. [PMID: 33810110 PMCID: PMC8005078 DOI: 10.3390/v13030523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.
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25
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Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil. PLoS Negl Trop Dis 2021; 15:e0009216. [PMID: 33684110 PMCID: PMC7971861 DOI: 10.1371/journal.pntd.0009216] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/18/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. Methods Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. Findings 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages. The ability to meaningfully quantify the absolute and relative risks of Congenital Zika Syndrome is contingent on the accurate identification of ZIKV infections in pregnant women and the long-term follow-up of children at risk. This study builds on the evidence base on ZIKV in pregnancy by not only examining pregnancy and birth outcomes, but also considering later onset manifestations of Congenital Zika Syndrome, conducting a deep and standardized investigation of infant outcomes. In addition, it used unprecedented repeated testing and the use of multiple diagnostic platforms, including qRT-PCR, IgM and IgG3 ELISAs, and PRNTs to identify ZIKV cases. The absolute risk of microcephaly was 2.9%, of calcifications and/or ventriculomegaly was 7.2%, of additional neurologic alterations was 5.3%, of ophthalmologic abnormalities was 7% and of dysphagia was 1.8%. The manifestations presented more frequently in isolation than in combination (i.e., less than 1% of the children experienced abnormalities across all of the domains simultaneously). Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination
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26
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Aragón N, Díaz C, Contreras A. Dental, Occlusal, and Craniofacial Features of Children With Microcephaly Due to Congenital Zika Infection: 3 Cases Report From Valle del Cauca, Cali-Colombia-2020. Cleft Palate Craniofac J 2021; 58:1318-1325. [PMID: 33563005 DOI: 10.1177/1055665621990978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Describes dental, occlusal, and craniofacial characteristics of 3 children aged 3 to 4 years with microcephaly due to congenital Zika infection in Cali Valle del Cauca, 2020. DESIGN Three children case report with congenital Zika virus microcephaly. SETTING Institutional. PATIENTS Three children with maternal viral infection confirmed by polymerase chain reaction during first trimester of pregnancy were included and were born from 2016 to 2017. INTERVENTIONS Oral and mouth functional examination was performed including soft tissue examination; lingual and labial frenulum; evaluation of swallowing and chewing; craniofacial analysis; dimension of dental arch; intercanine and intermolar distance, palate form; relationship and growth of maxilla, mandible, and facial dental midline using plaster models; and complementary image analysis. MAIN OUTCOME MEASURES Child and mother sociodemographic features, craniofacial measurements; dental and oral features; maxillary and mandibular measures; and speech, swallowing, and chewing disorders. RESULTS Small head circumference at birth and at the time of clinical evaluation was compared to normal children of approximately their age. Upper third of the face was short, and presence of hypertonic masticatory muscles with hypotonic swallowing muscles, dysphagia, dyslalia, bruxism, lip incompetence, tongue interposition, and hypersalivation and epilepsy were the main medical problem. They have complete primary dentition with normal dental morphology, tooth eruption altered, dental caries, and dental malocclusion was identified. CONCLUSION There are no changes in the dental formula and dental morphology in the deciduous dentition. They present severe chewing and speaking limitation, facial disproportion, and occlusal problems that warrant dental and medical attention.
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Affiliation(s)
- Natalia Aragón
- Dentistry School, Universidad del Valle, Cali, Colombia.,Group Periodontal Medicine, Universidad del Valle, Cali, Colombia
| | - Catalina Díaz
- Dentistry School, Universidad del Valle, Cali, Colombia
| | - Adolfo Contreras
- Dentistry School, Universidad del Valle, Cali, Colombia.,Group Periodontal Medicine, Universidad del Valle, Cali, Colombia
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27
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Leal MC, Seabra Ramos D, Pinto Bezerra T, Vilela AESC, Maciel RJDF, Rodrigues M, Lira M, Cavalcanti KPDS, Van der Linden V, Cordeiro MT, Miranda-Filho D, Ximenes R, Brickley EB, Caldas SS. The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly. Viruses 2021; 13:62. [PMID: 33466404 PMCID: PMC7824820 DOI: 10.3390/v13010062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.
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Affiliation(s)
- Mariana C. Leal
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Agamenon Magalhães Hospital, Recife 52070-230, Brazil;
| | - Danielle Seabra Ramos
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Medicine Department, Catholic University of Pernambuco, Recife 50050-900, Brazil
| | - Thiago Pinto Bezerra
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | | | - Rebeka Jacques de F. Maciel
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | - Mirella Rodrigues
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | - Mariana Lira
- Clinical Hospital, Federal University of Pernambuco, Recife 50740-900, Brazil; (M.L.); (K.P.d.S.C.)
| | - Karen Pena de Souza Cavalcanti
- Clinical Hospital, Federal University of Pernambuco, Recife 50740-900, Brazil; (M.L.); (K.P.d.S.C.)
- Immunopathology Laboratory Keizo Asami, Federal University of Pernambuco, Recife 50670-901, Brazil
| | | | - Marli T. Cordeiro
- Barão de Lucena Hospital, Recife 50731-000, Brazil; (V.V.d.L.); (M.T.C.)
| | | | - Ricardo Ximenes
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
| | | | - Silvio S. Caldas
- Surgery Department, Federal University of Pernambuco, Recife 50670-901, Brazil; (D.S.R.); (T.P.B.); (R.J.d.F.M.); (M.R.); (R.X.); (S.S.C.)
- Oswaldo Cruz University Hospital, University of Pernambuco, Recife 50100-130, Brazil;
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do Amaral YNDV, Malacarne J, Brandão PG, Brasil P, Nielsen-Saines K, Moreira MEL. Time to Evaluate the Clinical Repercussions of Zika Virus Vertical Transmission? A Systematic Review. Front Psychiatry 2021; 12:699115. [PMID: 34526920 PMCID: PMC8435783 DOI: 10.3389/fpsyt.2021.699115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Vertical transmission of Zika Virus (ZIKV) can be associated with several clinical features in newborn infants. The goal of the present review was to analyze the current state of knowledge regarding clinical repercussions following perinatal exposure to ZIKV in children up to 3 years of age. Methods: A systematic review of published studies was carried out, without the restriction of language or date of publication, identified in the databases PubMed, Virtual Health Library (BVS), Scopus, and Web of Science and the catalog for CAPES theses and dissertations. According to the proposed flowchart, the bibliographic search resulted in 1,563 papers. Of these, according to the eligibility criteria, 70 were selected for systematic review; all were published between 2016 and 2021. Results: Regarding clinical findings, 19 papers evaluated clinical imaging alterations, 21 ophthalmic manifestations, and 39 evaluated the central nervous system; of these, 15 analyzed neuro-psychomotor development. The remainder evaluated audiological (n = 14), nutritional (n = 14), orthopedic (n = 7), cardiorespiratory (n = 5), genitourinary (n = 3) or endocrinological (n = 1) manifestations. Conclusion: It is critical for studies to continue monitoring children with antenatal ZIKV exposure as they grow, given the unknown long-term repercussions of ZIKV and the recognized postnatal complications of this infection during pregnancy. Broader descriptions of observed clinical findings are also important in order to characterize the entire spectrum of disease in children. Systematic Review Registration: PROSPERO REGISTER: CRD42020205947.
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Affiliation(s)
| | - Jocieli Malacarne
- Department of Pediatrics, Instituto Fernandes Figueira, Rio de Janeiro, Brazil
| | | | - Patrícia Brasil
- Department of Acute Febrile Illnesses, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
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Gama GL, Silva BMD, Silva MBD, Ferreira RVB, Tavares JDS, Melo A. Mental health and burden in mothers of children with congenital Zika syndrome during COVID-19 pandemic. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-9304202100s200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate burden, frequency of anxiety and signs and symptoms of depression in mothers of children with congenital Zika syndrome (CZS) during the COVID-19 pandemic and the social isolation period. Methods: this is a cross-sectional study conducted with mothers who care for their children with CZS. The data were collected by an online form with questions regarding mother's socioeconomic conditions and questions related with Zarit burden scale and Beck's inventories on depression and anxiety. Spearman’s correlation tests and multiple regression analyzes were performed to assess factors related to mothers' burden and mental health. Results: 41 mothers were evaluated, 51.2% had mild burden, 39% had minimal anxiety and 73.2% did not have signs and symptoms of depression. Negative correlations were observed between levels of burden and maternal schooling (p=0.01), presence of signs and symptoms of anxiety and receiving financial aid (p<0.04) as well as the presence of signs and symptoms of anxiety and having children with seizures history (p=0.03). Conclusion: despite the risk of their children again being victims of an epidemic virus, mothers who care for their children with CZS did not present serious mental health impairments.
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Affiliation(s)
| | | | | | | | | | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Brasil
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Martinez SS, Pardo‐Hernandez H, Palacios C. Feeding modifications and additional primary caregiver support for infants exposed to Zika virus or diagnosed with congenital Zika syndrome: a rapid review of the evidence. Trop Med Int Health 2020; 25:1353-1361. [PMID: 32881216 PMCID: PMC7756506 DOI: 10.1111/tmi.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Infants exposed to Zika virus (ZIKV) or diagnosed with congenital Zika syndrome (CZVS) may present dysphagia, regurgitation and other feeding difficulties. They may require special feeding practices to minimise the risk of mortality, morbidity and developmental problems. Improving knowledge, skills and behaviours of caregivers may preserve health, maximise development and promote quality of life among affected infants. We reviewed intervention studies of modified feeding practices and additional primary caregiver support to improve outcomes among infants 0 to 12 months of age exposed to ZIKV or diagnosed with CZVS. METHODS Rapid review and meta-analysis. We searched PubMed/MEDLINE and contacted experts. The search is current to 18 July 2020. We planned a meta-analysis using fixed-effect models; if unfeasible, we intended to summarise studies narratively. We planned to assess risk of bias of included studies and quality of evidence using Cochrane guidance. RESULTS We identified 42 records for title and abstract screening; 14 were eligible for full-text assessment. Among these, no intervention studies were found. Eight observational studies reported on the nutritional status, feeding practices and outcomes among infants affected by ZIKV or diagnosed with CZVS. They are presented and discussed to provide a basis for future research. CONCLUSIONS While no intervention studies were found, evidence from eight observational studies highlights the need for early nutrition interventions and caregiver support among infants affected by ZIKV or diagnosed with CZSV. More research is needed to assess whether modifications of feeding practices and provision of additional primary caregiver support will impact outcomes of interest.
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Affiliation(s)
| | | | - Cristina Palacios
- Department of Dietetics and NutritionFlorida International UniversityMiamiFLUSA
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Cristina da Silva Rosa B, Hernandez Alves Ribeiro César CP, Paranhos LR, Guedes-Granzotti RB, Lewis DR. Speech-language disorders in children with congenital Zika virus syndrome: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 138:110309. [PMID: 32853874 DOI: 10.1016/j.ijporl.2020.110309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/27/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Having verified the true association between the Zika virus and the occurrence of microcephaly, studies were conducted to evaluate the effects of the infection on fetal development. Congenital Zika virus syndrome is a currently known condition but little addressed regarding speech, language, and hearing disorders in children. OBJECTIVE To conduct a systematic review of speech, language, and hearing disorders in children with congenital Zika virus syndrome. METHODS This systematic review followed the PRISMA instructions and the Joanna Briggs Institute guidelines, and it was registered in PROSPERO (CRD42018111764). The databases consulted were Cochrane, SciELO, PubMed, LILACS, Scopus, Web of Science, and ScienceDirect. OpenGrey and OpenThesis were used to partially capture the "grey literature". Observational studies of children with microcephaly due to congenital Zika virus syndrome were included. The risk of bias was analyzed using the 2017 Joanna Briggs Institute. RESULTS 707 records were obtained and, after excluding the duplicates, 644 studies remained. After applying the inclusion criteria, 24 articles were considered eligible. Children with congenital Zika virus syndrome presented abnormal persistence of primitive reflexes (94.7%), impaired cognitive development (95.1%), delayed neuropsychomotor development (between 92.8 and 100%), hypertonia (between 74.7% and 90.1%), impaired language development (between 68.42% and 100%), retrognathia (38.6%), craniofacial disproportion (between 32.9% and 95.8%), altered tongue frenulum (between 30% and 36.36%), the absence of stapedial reflexes (27.3%), dysphagia (between 14% and 88.9%), and hearing changes (between 5.8% and 68.42%). CONCLUSION Children with congenital Zika virus syndrome may have speech, language, and hearing disorders such as hearing loss, dysphagia, alteration in the tongue frenulum, and delays in neuropsychomotor and language development.
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Affiliation(s)
- Barbara Cristina da Silva Rosa
- Language and Hearing Sciences Department, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Raphaela Barroso Guedes-Granzotti
- Language and Hearing Sciences Department, Center for Biological and Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Doris Ruthy Lewis
- Professor at the Postgraduate at the Pontifical Catholic University of São Paulo, São Paulo, São Paulo, Brazil
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N. Costa MC, Cardim LL, Teixeira MG, Barreto ML, de Carvalho-Sauer RDCO, R. Barreto F, Itaparica Carvalho MS, Oliveira WK, França GVA, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Oliveira JF, Fernandes QHRF, Costa LC, Coelho GE, Paixao ES. Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †. Viruses 2020; 12:v12111228. [PMID: 33138282 PMCID: PMC7692842 DOI: 10.3390/v12111228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child-maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015-2017. METHODS Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. RESULTS The microcephaly/CZS case fatality rate was 10% (95% CI 9.2-10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63-2.83), and very low birth weight (OR = 3.77; 95% CI 2.20-6.46); late preterm births (OR = 1.65; 95% CI 1.21-2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46-8.02) and 5th minutes (OR = 4.13; 95% CI 2.78-6.13), among others. CONCLUSIONS A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.
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Affiliation(s)
- Maria Conceição N. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Luciana Lobato Cardim
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Maria Gloria Teixeira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Mauricio L. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Rita de Cassia Oliveira de Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
- East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia ZC 44570-550, Brazil
| | - Florisneide R. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Martha Suely Itaparica Carvalho
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Municipal Health Secretariat of Salvador, Bahia ZC 40010-010, Brazil
| | - Wanderson K. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília ZC 70675-731, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia ZC 70070-040, Brazil;
| | - Eduardo Hage Carmo
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Roberto F. S. Andrade
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Physics Institute, Federal University of Bahia, Salvador, Bahia ZC 40210-340, Brazil
| | - Moreno S. Rodrigues
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Rafael V. Veiga
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Juliane F. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | | | - Larissa C. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Giovanini E. Coelho
- Department of Communicable Diseases and Environmental Determinants of Health, Neglected, Tropical and Vector-Borne Diseases, Pan-American Health Organization/World Health Organization, Washington, WA 20037, USA;
| | - Enny S. Paixao
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Correspondence:
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Melo A, de Sales Tavares J, de Assis Costa M, Santana de Aguiar R, Malinger G, de Oliveira Melo F, Balbino da-Silva M, Luiz Fonseca Schamber-Reis B, Gama G, Tanuri A, Chimelli L, Oliveira-Szejnfeld P, M Ramos de Amorim M. Obstetric and perinatal outcomes in cases of congenital Zika syndrome. Prenat Diagn 2020; 40:1732-1740. [PMID: 32939752 DOI: 10.1002/pd.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe obstetric and perinatal outcomes in cases of congenital Zika syndrome (CZS). METHODS A dual prospective and retrospective cohort study involving 102 pairs of mothers and fetuses/children with CZS whose infection was confirmed by testing for the Zika virus in amniotic fluid, umbilical cord blood, and fragments from the placenta of the newborn infant (confirmed CZS), or by intrauterine imaging tests (neurosonography), and/or postnatal computed tomography (presumed CZS). RESULTS Suspicion of CZS was investigated by ultrasonography during pregnancy in 52.9% of cases. The principal prenatal imaging findings were ventriculomegaly (43.1%) and microcephaly (42.2%). Median gestational age at delivery was 39 weeks, with 15.7% being premature. Mean head circumference at birth was 30.0 ± 2.3 cm, with 66% of cases being classified as having microcephaly. Arthrogryposis was found in 10 cases (9.8%). There were no fetal deaths; however, nine neonatal deaths were recorded, and three autopsies were performed. CONCLUSION Neonatal mortality was high, almost 10%. Regarding the abnormalities of CZS, microcephaly, although common, was not present in all cases and intracranial findings need to be taken into consideration for diagnosis. Therefore, ultrasound screening during pregnancy should be systematized and expanded in endemic zones.
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Affiliation(s)
- Adriana Melo
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,UNIFACISA, Campina Grande, Brazil.,Federal University of Campina Grande (UFCG), Campina Grande, Brazil
| | | | | | | | - Gustavo Malinger
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Gabriela Gama
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,UNIFACISA, Campina Grande, Brazil
| | - Amilcar Tanuri
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Patricia Oliveira-Szejnfeld
- Federal University of São Paulo, São Paulo, Brazil.,Instituto D'Or de Pesquisa (IDOR), Rio de Janeiro, Brazil
| | - Melania M Ramos de Amorim
- Instituto de Pesquisa Professor Amorim Neto (IPESQ), Campina Grande, Brazil.,Federal University of Campina Grande (UFCG), Campina Grande, Brazil.,Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
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Quantitative definition of neurobehavior, vision, hearing and brain volumes in macaques congenitally exposed to Zika virus. PLoS One 2020; 15:e0235877. [PMID: 33091010 PMCID: PMC7580995 DOI: 10.1371/journal.pone.0235877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
Congenital Zika virus (ZIKV) exposure results in a spectrum of disease ranging from severe birth defects to delayed onset neurodevelopmental deficits. ZIKV-related neuropathogenesis, predictors of birth defects, and neurodevelopmental deficits are not well defined in people. Here we assess the methodological and statistical feasibility of a congenital ZIKV exposure macaque model for identifying infant neurobehavior and brain abnormalities that may underlie neurodevelopmental deficits. We inoculated five pregnant macaques with ZIKV and mock-inoculated one macaque in the first trimester. Following birth, growth, ocular structure/function, brain structure, hearing, histopathology, and neurobehavior were quantitatively assessed during the first week of life. We identified the typical pregnancy outcomes of congenital ZIKV infection, with fetal demise and placental abnormalities. We estimated sample sizes needed to define differences between groups and demonstrated that future studies quantifying brain region volumes, retinal structure, hearing, and visual pathway function require a sample size of 14 animals per group (14 ZIKV, 14 control) to detect statistically significant differences in at least half of the infant exam parameters. Establishing the parameters for future studies of neurodevelopmental outcomes following congenital ZIKV exposure in macaques is essential for robust and rigorous experimental design.
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Carvalho-Sauer RDCOD, Costa MDCN, Paixão ES, de Jesus Silva N, Barreto FR, Teixeira MG. Cross-sectional study of the anthropometric characteristics of children with congenital Zika syndrome up to 12 months of life. BMC Pediatr 2020; 20:479. [PMID: 33054749 PMCID: PMC7557056 DOI: 10.1186/s12887-020-02365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about physical development of children with Congenital Zika Syndrome (CZS). This study aims to evaluate the anthropometric characteristics of children with CZS up to 12 months. Methods This is a cross-sectional study developed with 46 children with CZS living in Bahia. We used the Public Health Events Register, Live Births Information System and Childcare Records of Primary Health Care Services. Descriptive analysis was performed by distributing absolute and relative frequencies and median and interquartile range. The Weight/Age (W/A), Length/Age (L/A), Weight/Length (W/L) and Head Circumference/Age (HC/A) indexes were calculated for each month and expressed in z-score values, and the results were evaluated individually and by group average. Values between ≥ − 2 and ≤ 2 standard deviations were used as reference. T-Student and Spearman’s Correlation Tests were applied to verify the existence of any relationship between maternal and children’s variables with the anthropometric indexes weight/age and height/age at birth and at 3, 6 and 12 months of age. Results The studied children had high proportions of low birth weight (23.9%), dysphagia (56.8%) and seizures (53.5%). The mean z-score for the HC/A index at birth was − 3.20 and remained below − 3 z-scores throughout the assessed period. The analysis of the indices equivalent to every single child’s anthropometric measurement showed a deficit in 20.4% of the W/A, 39.1% of the L/A, 9.2% of the W/L and 85.7% of the HC/A measurements. Distribution of the mean values of these anthropometric indices revealed a risk of delayed stature growth (L/A < -1 z-score). There was a statistically significant association between L/A at 12 months and dysphagia (p = 0.0148) and a positive correlation between breastfeeding time and W/A. No statistically significant correlation was found between any other tested variables. Conclusions We observed a deficit in the HC/A index, which is a common feature in CZS, but also a high proportion of W/A and L/A deficit. The average group z-score highlighted the risk of delay in stature growth for age, which calls attention to the need for health interventions, as this condition exposes them to a higher risk of morbidity and mortality.
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Affiliation(s)
- Rita de Cássia Oliveira de Carvalho-Sauer
- Bahia State Health Secretariat, Epidemiological Surveillance Service of the East Regional Health Center, Avenida Esperança, 406, Santo Antônio de Jesus, Bahia, ZC 44435-500, Brazil
| | | | - Enny S Paixão
- London School of Hygiene and Tropical Medicine, London Keppel St, Bloomsbury, London, WC1E 7HT, UK.
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Parque Tecnológico da Bahia. Rua Mundo, 121 - Trobogy, Salvador, Bahia, ZC 41745-715, Brazil
| | - Florisneide Rodrigues Barreto
- Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s / n. Canela, Salvador, Bahia, ZC-40.110.040, Brazil
| | - Maria Gloria Teixeira
- Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s / n. Canela, Salvador, Bahia, ZC-40.110.040, Brazil
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Carroll C, Booth A, Campbell F, Relton C. What are the implications of Zika Virus for infant feeding? A synthesis of qualitative evidence concerning Congenital Zika Syndrome (CZS) and comparable conditions. PLoS Negl Trop Dis 2020; 14:e0008731. [PMID: 33085668 PMCID: PMC7605709 DOI: 10.1371/journal.pntd.0008731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/02/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
If a mother contracts the Zika Virus before or during pregnancy, then there is a risk of the child developing Congenital Zika Syndrome (CZS). An infant can then experience problems feeding due to the specific physical and developmental consequences of Congenital Zika Syndrome (CZS), such as microcephaly, dysphagia and an increased likelihood of choking. This qualitative evidence synthesis accesses direct and indirect evidence to inform WHO infant feeding guidelines. We conducted a qualitative evidence synthesis of the values and preferences of relevant stakeholders (e.g. pregnant women, mothers, family members and health practitioners) concerning infant (0-2 years) feeding in the presence of: 1) CZS (the'direct evidence'); 2) severe disability and nonprogressive, chronic encephalopathies ('indirect evidence'), which present with similar problems. Authors' findings were extracted, synthesised using thematic synthesis techniques, and confidence in the findings were assessed using GRADE-CERQual. Six CZS-specific studies (all from Brazil) were included in the direct evidence, with a further eight indirect studies reporting feeding difficulties in infants with severe disability and nonprogressive, chronic encephalopathies. Included studies highlighted: breast-feeding represented the preference for all mothers in the studies in both reviews, and the inability to do so affected bonding between parents and child, and generated fear and anxiety relating to feeding choices, especially around the risks of choking and swallowing; the perception that health professionals were often unable to offer appropriate advice; the potential value of training; and a strong desire to achieve individual maternal autonomy in infant feeding decisions. Confidence in most findings ranged from low to moderate. The evidence base has limitations, but consistently reported that parents of children with feeding difficulties due to Congenital Zika Syndrome, or similar, need information, advice and counselling, and substantial emotional support. Parents perceive that these needs are often neither recognised nor satisfied; optimal feeding and support strategies for this population have not yet been identified.
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Affiliation(s)
- Christopher Carroll
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Andrew Booth
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Fiona Campbell
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Clare Relton
- Senior Lecturer in Clinical Trials, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
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Oliveira DMDS, Miranda-Filho DDB, Ximenes RADA, Montarroyos UR, Martelli CMT, Brickley EB, Gouveia MDCL, Ramos RC, Rocha MÂW, Araujo TVBD, Eickmann SH, Rodrigues LC, Bernardes JPDOS, Pinto MHT, Soares KPND, Araújo CMTD, Militão-Albuquerque MDFP, Santos ACOD. Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly. Dysphagia 2020; 36:583-594. [PMID: 32886254 PMCID: PMC8289769 DOI: 10.1007/s00455-020-10173-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/24/2020] [Indexed: 01/12/2023]
Abstract
Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015–2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil.
| | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil.,Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Ulisses Ramos Montarroyos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães, Campus da UFPE - Av. Prof. Moraes Rego, S/N - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Elizabeth B Brickley
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | | | - Regina Coeli Ramos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Maria Ângela Wanderley Rocha
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | | | - Sophie Helena Eickmann
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Jeyse Polliane de Oliveira Soares Bernardes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Maria Helena Teixeira Pinto
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | | | | | | | - Ana Célia Oliveira Dos Santos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
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Sousa IBAD, Souza C, Barbosa MDS, Croda JHR, Gonçalves CCM, Bernardes SS, Marchioro SB. Gestational outcomes in women infected by Zika virus during pregnancy in Mato Grosso do Sul, Brazil: A cross-sectional study. Int J Infect Dis 2020; 98:359-365. [PMID: 32619757 DOI: 10.1016/j.ijid.2020.06.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to describe the demographic and clinical parameters of women infected by Zika virus who had infants with stigmata of Congenital Zika Syndrome (CZS) versus those who had normal-appearing infants at birth, thereby providing further details on the clinical caveats of neonatal ZIKV infection. METHODOLOGY This cross-sectional study was performed in the state of Mato Grosso do Sul, Central-West region of Brazil, and included 117 mother-infant pairs who were interviewed and 120 gestational outcomes. All mothers had laboratory confirmation by qRT-PCR of ZIKV infection during pregnancy. RESULTS The prevalence of congenital abnormalities related to ZIKV was 2.69 cases per 10,000 live births during this period. Exanthem was the main clinical finding, observed in 92.5% of the mothers in this study. Regarding the timing of ZIKV infection, the first trimester was the most frequent time of infection among mothers of infants with CZS (54.55%) (p=0.0007). The case fatality rate was 5% (n=6). Among the 23 children who were classified as having CZS, 13 (56.52%) of them presented with microcephaly. Only 13 (56.52%) children with CZS were tested by qRT-PCR for ZIKV infection at birth, five (38%) were positive. CONCLUSIONS This study highlights the congenital alterations of ZIKV infection during pregnancy in an epidemic burst, demonstrating that the alterations found in other studies are similar to the present research.
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Affiliation(s)
| | - Cristina Souza
- Faculty of Health Sciences, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Julio Henrique Rosa Croda
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil; Faculty of Health Sciences, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Sara Santos Bernardes
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil; Laboratory of Tissue Microenviroment, Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Beutinger Marchioro
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil; Institute of Health Sciences, Immunology Laboratory Federal University of Bahia, Salvador, Bahia, Brazil.
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Frota LMDCP, Sampaio RF, Miranda JL, Brasil RMC, Gontijo APB, Mambrini JVDM, Brandão MDB, Mancini MC. Children with congenital Zika syndrome: symptoms, comorbidities and gross motor development at 24 months of age. Heliyon 2020; 6:e04130. [PMID: 32577556 PMCID: PMC7303558 DOI: 10.1016/j.heliyon.2020.e04130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability. AIMS To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development. METHODS AND PROCEDURES Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function. OUTCOMES AND RESULTS Significant associations (p < 0.001) were observed between number of comorbidities/symptoms and dimensions A (r = -0.57) and B (r = -0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88. CONCLUSIONS AND IMPLICATIONS The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months.
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Affiliation(s)
- Lêda Maria da Costa Pinheiro Frota
- Interinstitutional Doctorate Program (Dinter) UFC-UFMG Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Center for Treatment and Early Stimulation - NUTEP, Rua - Papi Júnior, 1225, Rodolfo Teófilo,60, 430-235, Fortaleza, Ceará, Brazil
| | - Rosana Ferreira Sampaio
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - José Lucivan Miranda
- Department of Maternal and Child Health. Universidade Federal do Ceará, Center for Treatment and Early Stimulation - NUTEP, Rua -Papi Júnior, 1225, Rodolfo Teófilo, 60, 430-235, Fortaleza, Ceará, Brazil
| | - Rita Maria Cavalcante Brasil
- Center for Treatment and Early Stimulation - NUTEP, Rua Papi Júnior, 1225, Rodolfo Teófilo, 60, 430-235, Fortaleza, Ceará, Brazil
| | - Ana Paula Bensemann Gontijo
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais. Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | | | - Marina de Brito Brandão
- Department of Occupational Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Marisa Cotta Mancini
- Department of Occupational Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
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de Oliveira AMM, de Melo EGM, Mendes MLT, Dos Santos Oliveira SJG, Tavares CSS, Vaez AC, de Vasconcelos SJA, Santos HP, Santos VS, Martins-Filho PRS. Oral and maxillofacial conditions, dietary aspects, and nutritional status of children with congenital Zika syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:71-77. [PMID: 32493680 DOI: 10.1016/j.oooo.2020.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to investigate oral and maxillofacial outcomes in children with congenital Zika syndrome (CZS) and the presence of nonnutritive sucking habits, functional habits, and features related to breastfeeding and nutrition of these children. STUDY DESIGN We conducted a cross-sectional study with 45 children with CZS and 50 healthy controls in Sergipe state, Brazil, from February 2018 to June 2018. Demographic and clinical data, including breastfeeding and feeding data, were obtained for each child. Additionally, oral and maxillofacial evaluation was performed. RESULTS Low weight (prevalence rate [PR] 8.33; 95% confidence interval [CI] 2.02-34.45), nonexclusive breastfeeding up to 6 months (PR 1.56; 95% CI 1.18-2.08); mouth breathing (PR 3.46; 95% CI 1.83-6.52); difficulty in swallowing (PR 6.00; 95% CI 2.53-14.25); and excessive salivation (PR 4.81; 95% CI 2.18-10.62) were more frequent in children with CZS. Children with CZS were more likely to have abnormal insertion of the upper labial frenulum (PR 7.04; 95% CI 2.23-22.20); ogival palate (PR 3.70; 95% CI 1.63-8.40), dental enamel defects (PR 2.22; 95% CI 1.05-4.69); and delayed dental eruption (PR 8.89; 95% CI 1.16-68.32) compared with healthy children. CONCLUSIONS Children with CZS had a higher frequency of problems related to breastfeeding, low weight, and oral and maxillofacial abnormalities compared with healthy children.
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Affiliation(s)
- Ana Márcia Menezes de Oliveira
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil; Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil
| | - Elisama Gomes Magalhães de Melo
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil; Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil
| | | | - Sheila Jaqueline Gomes Dos Santos Oliveira
- Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Carolina Santos Souza Tavares
- Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Andreia Centenaro Vaez
- Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil; Postgraduate Program in Nursing, Federal University of Sergipe, Sergipe, Brazil
| | - Sara Juliana Abreu de Vasconcelos
- Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victor Santana Santos
- Department of Nursing, Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | - Paulo Ricardo Saquete Martins-Filho
- Postgraduate Program in Dentistry, Federal University of Sergipe, Aracaju, Brazil; Investigative Pathology Laboratory, Federal University of Sergipe, Sergipe, Brazil; Postgraduate Program in Health Sciences, Federal University of Sergipe, Sergipe, Brazil.
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Pereira HVFS, Dos Santos SP, Amâncio APRL, de Oliveira-Szejnfeld PS, Flor EO, de Sales Tavares J, Ferreira RVB, Tovar-Moll F, de Amorim MMR, Melo A. Neurological outcomes of congenital Zika syndrome in toddlers and preschoolers: a case series. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:378-387. [PMID: 32199080 DOI: 10.1016/s2352-4642(20)30041-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.
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Affiliation(s)
- Heloisa Viscaino Fernandes Souza Pereira
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
| | - Stella Pinto Dos Santos
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Patricia Soares de Oliveira-Szejnfeld
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil; Foundation Institute for Education and Research in Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Edneusa Oliveira Flor
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Fernanda Tovar-Moll
- Institute of Biomedical Sciences and National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Melania Maria Ramos de Amorim
- Research Institute Professor Amorim Neto, Campina Grande, Brazil; Federal University of Campina Grande, Campina Grande, Brazil; The Professor Fernando Figueira Integral Medicine Institute, Recife, Brazil
| | - Adriana Melo
- Research Institute Professor Amorim Neto, Campina Grande, Brazil; Federal University of Campina Grande, Campina Grande, Brazil; UNIFACISA - University Center, Campina Grande, Brazil
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Fábia Cabral Cavalcanti A, Aguiar YPC, Oliveira Melo ASD, Leite Cavalcanti A, D'Ávila S. Breastfeeding Behavior in Brazilian Children with Congenital Zika Syndrome. Int J Dent 2020; 2020:1078250. [PMID: 32256591 PMCID: PMC7102404 DOI: 10.1155/2020/1078250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 02/05/2020] [Accepted: 02/22/2020] [Indexed: 01/21/2023] Open
Abstract
Congenital Zika Syndrome (CZS) is a condition that has emerged only recently, bringing together multiple changes, including significant changes in the stomatognathic system, which may compromise sucking behavior and consequently the breastfeeding practice. The aim of this study was to investigate the breastfeeding behaviors in children with CZS. A longitudinal study was carried out in two reference centers in Northeastern Brazil. The nonprobabilistic sample consisted of 79 children diagnosed with physical, neurological, and behavioral alterations compatible with CZS. Information regarding the child, nutritive, and nonnutritive sucking behavior and changes related to the sucking reflex was collected. Data were presented through descriptive and inferential statistics. In the bivariate analyses, the chi-squared test was used and 5% significance level was adopted. The majority of children had severe microcephaly (59.7%). Breastfeeding was performed at birth in most of CZS children (89.9%) but only 36.6% of them presented exclusive breastfeeding in the six months of life. Bottle feeding and pacifier were used in 89.9% and 55.7%, respectively. Sucking and swallowing difficulties and occurrence of gastroesophageal reflux were observed in 27.8%, 48.0%, and 29.2% of children, respectively. Early weaning was associated with bottle feeding (p=0.005) and pacifier sucking (p=0.003). Although breastfeeding practice at birth constitutes a behavior adopted by most of mothers, adherence to this exclusive habit until the first six months of life was low since the children presenting a large number of comorbidities with direct interference in the suction reflex, sucking, and swallowing difficulty.
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Affiliation(s)
| | | | | | | | - Sergio D'Ávila
- Associate Professor, Postgraduate Program in Dentistry, State University of Paraiba, Campina Grande, Brazil
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Gusmão TPDL, Faria ABSD, Leão Filho JC, Carvalho ADAT, Gueiros LAM, Leão JC. Dental changes in children with congenital Zika syndrome. Oral Dis 2019; 26:457-464. [DOI: 10.1111/odi.13238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2019] [Accepted: 11/10/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Teresa Paula de Lima Gusmão
- Oral Medicine Unit Departamento de Clinica e Odontologia Preventiva Federal University of Pernambuco Pernambuco Brazil
| | | | - Jair Carneiro Leão Filho
- Oral Medicine Unit Departamento de Clinica e Odontologia Preventiva Federal University of Pernambuco Pernambuco Brazil
| | | | - Luiz Alcino Monteiro Gueiros
- Oral Medicine Unit Departamento de Clinica e Odontologia Preventiva Federal University of Pernambuco Pernambuco Brazil
| | - Jair Carneiro Leão
- Oral Medicine Unit Departamento de Clinica e Odontologia Preventiva Federal University of Pernambuco Pernambuco Brazil
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Zika virus infection in pregnancy and infant growth, body composition in the first three months of life: a cohort study. Sci Rep 2019; 9:19198. [PMID: 31844129 PMCID: PMC6915782 DOI: 10.1038/s41598-019-55598-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/27/2019] [Indexed: 12/03/2022] Open
Abstract
The implications of Zika Virus exposure in pregnancy for early infant growth remains poorly described. The main goal of this study is to compare the growth, body composition, and feeding modality of infants in the first three months of life by prenatal Zika Virus exposure status. We selected an analytical cohort of 115 infants born without microcephaly, comprising 56 infants with qRT-PCR confirmed exposure to ZIKV during gestation and 59 infants born to women with presumptively no evidence of ZIKV in pregnancy. Infants were evaluated at birth, 1 and 3 months of age in terms of anthropometrics, body composition All the results were adjusted by maternal age, maternal BMI and gestational age. We observe no differences between anthropometric measurements at birth. Mothers in exposed group showed higher BMI. At 1 month and 3 months of age there were differences in mid arm circumference, arm muscle circumference and fat free mass. Weight and length was less in the ZIKV exposed in pregnancy infants and statistically different at 3 month of age. The findings of this investigation provide new evidence that ZIKV exposure in pregnancy may be associated with differences in body composition.
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Gouveia HJCB, Manhães-de-Castro R, Costa-de-Santana BJR, Mendonça CR, Albuquerque G, Visco DB, Lacerda DC, Toscano AE. Maternal exposure to busulfan reduces the cell number in the somatosensory cortex associated with delayed somatic and reflex maturation in neonatal rats. J Chem Neuroanat 2019; 103:101710. [PMID: 31706849 DOI: 10.1016/j.jchemneu.2019.101710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 01/31/2023]
Abstract
Busulfan is a bifunctional alkylating agent used for myeloablative conditioning and in the treatment of chronic myeloid leukemia due to its ability to cause DNA damage. However, in rodent experiments, busulfan presented a potential teratogenic and cytotoxic effect. Studies have evaluated the effects of busulfan on fetuses after administration in pregnancy or directly on pups during the lactation period. There are no studies on the effects of busulfan administration during pregnancy on offspring development after birth. We investigated the effects of busulfan on somatic and reflex development and encephalic morphology in young rats after exposure in pregnancy. The pregnant rats were exposed to busulfan (10 mg/kg, intraperitoneal) during the early developmental stage (days 12-14 of the gestational period). After birth, we evaluated the somatic growth, maturation of physical features and reflex-ontogeny during the lactation period. We also assessed the effects of busulfan on encephalic weight and cortical morphometry at 28 days of postnatal life. As a result, busulfan-induced pathological changes included: microcephaly, evaluated by the reduction of cranial axes, delay in reflex maturation and physical features, as well as a decrease in the morphometric parameters of somatosensory and motor cortex. Thus, these results suggest that the administration of a DNA alkylating agent, such as busulfan, during the gestational period can cause damage to the central nervous system in the pups throughout their postnatal development.
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Affiliation(s)
- Henrique J C B Gouveia
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Bárbara J R Costa-de-Santana
- Post Graduate Program in Neuropsychiatry and Behavioral Sciences, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Carolina R Mendonça
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Glayciele Albuquerque
- Post Graduate Program in Physiotherapy, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego Bulcão Visco
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Diego Cabral Lacerda
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ana Elisa Toscano
- Department of Nursing, CAV, Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil.
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Venancio FA, Bernal MEQ, Ramos MDCDBV, Chaves NR, Hendges MV, de Souza MMR, de Medeiros MJ, Pinto CDBS, Falcão de Oliveira E. Congenital Zika Syndrome in a Brazil-Paraguay-Bolivia border region: Clinical features of cases diagnosed between 2015 and 2018. PLoS One 2019; 14:e0223408. [PMID: 31584972 PMCID: PMC6777783 DOI: 10.1371/journal.pone.0223408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/21/2019] [Indexed: 02/02/2023] Open
Abstract
Congenital Zika Syndrome (CZS) is a unique pattern of congenital abnormalities found in fetuses and neonates infected with the Zika virus (ZIKV). Here, we clinically identify and characterize infants with CZS between 2015 and 2018 in Mato Grosso do Sul, Brazil-a border area with Paraguay and Bolivia. This cross-sectional study, based on primary and secondary data, tracks the cases registered in the Brazilian Public Health Reporting System through the following stages: (1) preliminary data analysis, (2) identification of the congenital syndrome cases, (3) etiologic classification of the cases, (4) active search, and (5) clinical assessment. Of the 72 investigated cases, 16 were probable cases of CZS. Of these, it was only possible to clinically assess 11 infants. Considering the 16 probable cases of CZS, nine were classified as confirmed cases, and five as potential cases of the syndrome. Regarding clinical features, brain palsy was identified in all analyzed infants. Moreover, microcephaly and pseudobulbar syndrome were found in eight infants, and hydrocephalus was found in three individuals. In addition to these conditions, seven children were malnourished. Our study may provide significant insights for other researches that aim to elucidate CZS and its clinical and populational consequences.
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Affiliation(s)
- Fabio Antonio Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
| | | | | | - Neuma Rocha Chaves
- Coordenadoria de Vigilância Epidemiológica, Secretaria Municipal de Saúde Pública de Campo Grande, Campo Grande, Brasil
| | | | | | | | | | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
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Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res 2019; 8:1433. [PMID: 31754425 PMCID: PMC6852328 DOI: 10.12688/f1000research.19918.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review. Methods: We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019. Results: We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I
2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I
2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I
2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I
2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I
2=74.6%). In case-control studies, selection of controls from hospitals could have biased results. Conclusions: The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
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Affiliation(s)
| | - Kaspar Walter Meili
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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Chimelli L, Moura Pone S, Avvad-Portari E, Farias Meira Vasconcelos Z, Araújo Zin A, Prado Cunha D, Raposo Thompson N, Lopes Moreira ME, Wiley CA, da Silva Pone MV. Persistence of Zika Virus After Birth: Clinical, Virological, Neuroimaging, and Neuropathological Documentation in a 5-Month Infant With Congenital Zika Syndrome. J Neuropathol Exp Neurol 2019; 77:193-198. [PMID: 29346650 DOI: 10.1093/jnen/nlx116] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
During the Zika epidemic in Brazil, a baby was born at term with microcephaly and arthrogryposis. The mother had Zika symptoms at 10 weeks of gestation. At 17 weeks, ultrasound showed cerebral malformation and ventriculomegaly. At 24 weeks, the amniotic fluid contained ZIKV RNA and at birth, placenta and maternal blood were also positive using RT-qPCR. At birth the baby urine contained ZIKV RNA, whereas CSF at birth and urine at 17 days did not. Seizures started at 6 days. EEG was abnormal and CT scan showed cerebral atrophy, calcifications, lissencephaly, ventriculomegaly, and cerebellar hypoplasia. Bacterial sepsis at 2 months was treated. A sudden increase in head circumference occurred at 4 months necessitating ventricle-peritoneal shunt placement. At 5 months, the infant died with sepsis due to bacterial meningitis. Neuropathological findings were as severe as some of those found in neonates who died soon after birth, including hydrocephalus, destructive lesions/calcification, gliosis, abnormal neuronal migration, dysmaturation of nerve cells, hypomyelination, loss of descending axons, and spinal motor neurons. ZIKV RNA was detected only in frozen brain tissue using RT-qPCR, but infected cells were not detected by in situ hybridization. Progressive gliosis and microgliosis in the midbrain may have contributed to aqueduct compression and subsequent hydrocephalus. The etiology of progressive disease after in utero infection is not clear and requires investigation.
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Affiliation(s)
- Leila Chimelli
- Laboratory of Neuropathology, State Institute of Brain and UFRJ
| | | | | | | | | | | | | | | | - Clayton A Wiley
- National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF) - Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil; and Division of Neuropathology, UPMC Presbiterian Hospital, Pittsburgh, Pennsylvania
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The Spectrum of Developmental Disability with Zika Exposure: What Is Known, What Is Unknown, and Implications for Clinicians. J Dev Behav Pediatr 2019; 40:387-395. [PMID: 30921103 PMCID: PMC7713528 DOI: 10.1097/dbp.0000000000000665] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinicians who treat children with neurodevelopmental disabilities may encounter infants with congenital Zika syndrome or those exposed to Zika virus (ZIKV), either in utero or postnatally, in their practice and may have questions about diagnosis, management, and prognosis. In this special report, we reviewed the current literature to provide a comprehensive understanding of the findings and needs of children exposed to ZIKV in utero and postnatally. The current literature is sparse, and thus, this review is preliminary. We found that infants and children exposed to ZIKV in utero have a variety of health and developmental outcomes that suggest a wide range of lifelong physical and developmental needs. Postnatal exposure does not seem to have significant long-lasting health or developmental effects. We provide a comprehensive examination of the current knowledge on health and developmental care needs in children exposed to Zika in utero and postnatally. This can serve as a guide for health care professionals on the management and public health implications of this newly recognized population.
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