Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus

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.

Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings

“…In particular, we purposely assessed if also the degree of inflammatory markers affected these parameters, and we did not find any significant relationships. This is a promising finding if we consider that, recently, infants exposed to Zika virus in utero could develop microcefalia and neuropsychiatric symptoms during follow-up [ 9 ].…”

“…During the last decade, we learnt that congenital cytomegalovirus infection, even when newborns are completely asymptomatic, is associated with a significant degree of sensorineural hearing loss and neuropsychiatric involvement [ 8 ]. Recent data from a long-term follow-up of children exposed in utero to a newly identified virus, the Zika virus, showed clinical sequelae, even in those children that were not vertically infected [ 9 ], further highlighting the importance of establishing a comprehensive follow-up of children exposed to viruses in utero.…”

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

“…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.…”

Psychological Impact of the COVID-19 Pandemic on Pregnant Women

“…Also, pregnant women faced the related risk of potential clinical consequences of SARS-CoV-2 infection for the fetus ( 6 – 8 ). The natural history of other viral infections [rubella, varicella-zoster virus ( 9 ), cytomegalovirus ( 10 ), and zika virus ( 11 )] during pregnancy clearly shows that exposed newborns may have a wide range of consequences, from asymptomatic infection to severe disease, congenital malformation, and death (both intrauterine and postnatal). Due to initial uncertainties, almost all national societies opted for a precautionary approach that included mother–newborn separation after delivery and formula feeding in the hypothesis that mothers could transmit the infection postnatally to a susceptible newborn ( 12 ).…”