1
|
Stringer EM, Martinez E, Blette B, Toval Ruiz CE, Boivin M, Zepeda O, Stringer JSA, Morales M, Ortiz-Pujols S, Familiar I, Collins M, Chavarria M, Goldman B, Bowman N, de Silva A, Westreich D, Hudgens M, Becker-Dreps S, Bucardo F. Neurodevelopmental Outcomes of Children Following In Utero Exposure to Zika in Nicaragua. Clin Infect Dis 2021; 72:e146-e153. [PMID: 33515459 PMCID: PMC7935385 DOI: 10.1093/cid/ciaa1833] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Neurodevelopmental outcomes of asymptomatic children exposed to Zika virus (ZIKV) in utero are not well characterized. Methods We prospectively followed 129 newborns without evidence of congenital Zika syndrome (CZS) up to 24 months of age. Participants were classified as ZIKV exposed or ZIKV unexposed. The Mullen Scales of Early Learning (MSEL) was administered in the participants’ homes at 6, 12, 15, 18, 21, and 24 months of age by trained psychologists. Sociodemographic data, medical history, and infant anthropometry at birth were collected at each home visit. Our primary outcome was the Mullen Early Learning Composite Score (ECL) at 24 months of age between our 2 exposure groups. Secondary outcomes were differences in MSEL subscales over time and at 24 months. Results Of 129 infants in whom exposure status could be ascertained, 32 (24.8%) met criteria for in utero ZIKV exposure and 97 (75.2%) did not. There were no differences in maternal age, maternal educational attainment, birthweight, or gestational age at birth between the 2 exposure groups. The adjusted means and standard errors (SEs) for the ELC score between the ZIKV-exposed children compared to ZIKV-unexposed children were 91.4 (SE, 3.1) vs 96.8 (SE, 2.4) at 12 months and 93.3 (SE, 2.9) vs 95.9 (SE, 2.3) at 24 months. In a longitudinal mixed model, infants born to mothers with an incident ZIKV infection (P = .01) and low-birthweight infants (<2500 g) (P = .006) had lower composite ECL scores. Conclusions In this prospective cohort of children without CZS, children with in utero ZIKV exposure had lower neurocognitive scores at 24 months.
Collapse
Affiliation(s)
- Elizabeth M Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelin Martinez
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Bryan Blette
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christian Eduardo Toval Ruiz
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Michael Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - Omar Zepeda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marlen Morales
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Shiara Ortiz-Pujols
- Division of Endocrinology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
| | - Matthew Collins
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Meylin Chavarria
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| | - Barbara Goldman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Natalie Bowman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Filemon Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua at León, Managua, Nicaragua
| |
Collapse
|