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. 2019 Aug;25(8):1213-1217.
doi: 10.1038/s41591-019-0496-1. Epub 2019 Jul 8.

Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children

Karin Nielsen-Saines  1 , Patrícia Brasil  2 , Tara Kerin  3 , Zilton Vasconcelos  2 , Claudia Raja Gabaglia  4 , Luana Damasceno  2 , Marcos Pone  2 , Liege M Abreu de Carvalho  2 , Sheila M Pone  2 , Andrea A Zin  2 , Irena Tsui  3 , Tania Regina S Salles  2 , Denise Cotrim da Cunha  2 , Roozemerie Pereira Costa  2 , Jociele Malacarne  2 , Ana Beatriz Reis  2 , Renata Hydee Hasue  5 , Carolina Y P Aizawa  5 , Fernanda F Genovesi  5 , Christa Einspieler  6 , Peter B Marschik  6   7 , José Paulo Pereira  2 , Stephanie L Gaw  8 , Kristina Adachi  3 , James D Cherry  3 , Zhiheng Xu  9   10 , Genhong Cheng  3 , Maria Elisabeth Moreira  11
Affiliations

Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children

Karin Nielsen-Saines et al. Nat Med. 2019 Aug.

Abstract

We report neurodevelopmental outcomes in 216 infants followed since the time of PCR-confirmed maternal Zika virus (ZIKV) infection in pregnancy during the Rio de Janeiro epidemic of 2015-2016 (refs. 1,2). Neurodevelopment was assessed by Bayley Scales of Infant and Toddler Development, third edition (Bayley-III; cognitive, language and motor domains) in 146 children and through neurodevelopment questionnaires/neurological examinations in 70 remaining children. Complete eye exams (n = 137) and hearing assessments (n = 114) were also performed. Below-average neurodevelopment and/or abnormal eye or hearing assessments were noted in 31.5% of children between 7 and 32 months of age. Among children assessed by Bayley-III, 12% scored below -2 s.d. (score <70; a score of 100 ± 2 s.d. is the range) in at least one domain; and 28% scored between -1 and -2 s.d. in any domain (scores <85-70). Language function was most affected, with 35% of 146 children below average. Improved neurodevelopmental outcomes were noted in female children, term babies, children with normal eye exams and maternal infection later in pregnancy (P = 0.01). We noted resolution of microcephaly with normal neurodevelopment in two of eight children, development of secondary microcephaly in two other children and autism spectrum disorder in three previously healthy children in the second year of life.

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Figures

Figure 1:
Figure 1:
Flow diagram of mother-infant pair enrollment and follow-up in the Rio de Janeiro Zika cohort.
Figure 2:
Figure 2:. Bayley-III assessments in 146 children between the ages of 7 to 32 months.
Very above average: > 2 SD, score > 131; Above average: 1 to 2 SD, score 116 to 130; Average: −1 to 1 SD, score 85 to 115; Below average: −1 to – 2 SD, score 84 to 70; Very below average: < - 2 SD, score < 70. Populational percentages are shown at the top of each bar.
Figure 3:
Figure 3:. Gestational age at time of maternal Zika virus infection in 244 pregnancies.
Adverse pregnancy and infant outcomes by week of maternal ZIKV infection during gestation. Adverse pregnancy outcomes are fetal loss. Infant outcomes include below average/ abnormal neurodevelopment and/or abnormal eye and/or abnormal hearing assessments between 7 to 32 months of age.
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