Language delay was associated with a smaller head circumference at birth in asymptomatic infants prenatally exposed to the Zika virus

Andrade, Laura Medeiros; Méio, Maria Dalva Barbosa Baker; Gomes, Saint Clair; Souza, Juliana Paiva de; Figueiredo, Mirza Rocha de; Costa, Roozemeria Pereira; Brasil, Patrícia; Nielsen‐Saines, Karin; Brickley, Elizabeth B; Moreira, Maria Elisabeth Lopes

doi:10.1111/apa.15878

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…Class 3 FMI and the predominant dolichocephalic facial biotype occurred frequently at CZS (Table 2 ), being these craniofacial features previously reported [ 25 , 31 , 33 ]. On the other hand, our controls presented a mesencephalic biotype, which is typical in Colombians at this age [ 30 , 32 , 34 ].…”

Section: Discussionsupporting

confidence: 53%

Craniofacial and dental features in children aged 3–5 years with congenital Zika syndrome

et al. 2023

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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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Section: Discussionsupporting

confidence: 53%

Craniofacial and dental features in children aged 3–5 years with congenital Zika syndrome

et al. 2023

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“…Previous studies evaluating the neurodevelopmental outcome of normocephalic infants born to ZIKV exposed women found significant anomalies in neurodevelopment. However, these studies did not include an appropriate control group for comparison [ 12 – 15 , 30 – 32 ] or had a high risk of selection bias [ 33 – 36 ]. A study by Andrade et al [ 32 ] used a similar methodology to study exposed infants observing a higher rate of receptive language delay, but the absence of a control group limited the study; our study did not find any differences in receptive or expressive language between exposed and un exposed infants using the same Bayley III score.…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies did not include an appropriate control group for comparison [ 12 – 15 , 30 – 32 ] or had a high risk of selection bias [ 33 – 36 ]. A study by Andrade et al [ 32 ] used a similar methodology to study exposed infants observing a higher rate of receptive language delay, but the absence of a control group limited the study; our study did not find any differences in receptive or expressive language between exposed and un exposed infants using the same Bayley III score. Aguilar-Ticona et al [ 37 ] included an appropriate control group showing mild cognitive delay and auditory behavioral abnormalities in infants of ZIKV exposed women but was limited by small sample size and wide ranges in confidence intervals of relative risks describing these associations.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women

et al. 2022

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An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration: www.clinicaltrials.gov, NCT02943304.

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“…The ages at which the children were evaluated were very heterogeneous, as were the neurobehavioral testing approaches. Out of a total of 12 available studies, eight of them used the BSDI-III mainly during the second or third year of life, and the most consistent delays were found in language followed by motor domains ( Lopes Moreira et al, 2018 ; Faiçal et al, 2019 ; Abtibol-Bernardino et al, 2020 ; Peçanha et al, 2020 ; Andrade et al, 2021 ). Only one study assessed the temporal trajectory of the neurodevelopment in those infants.…”

Section: Congenital Zika Syndromementioning

confidence: 99%

Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects

et al. 2022

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Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.

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Language delay was associated with a smaller head circumference at birth in asymptomatic infants prenatally exposed to the Zika virus

Cited by 7 publications

References 30 publications

Craniofacial and dental features in children aged 3–5 years with congenital Zika syndrome

Craniofacial and dental features in children aged 3–5 years with congenital Zika syndrome

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women

Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects

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