paula sobral Silva
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Sophie Helena Eickmann
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Ricardo Arraes de Alencar Ximenes
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Ulisses Ramos Montarroyos
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Marília de Carvalho Lima
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Abstract
Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in children with different levels of ZIKV-related microcephaly or with prenatal ZIKV exposure in the absence of microcephaly. Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVxposure confirmed by maternal RT-PCR testing and no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument, and a SWYC adapted form to compare severe cases. Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were at risk of development delay, and presented similar performance whether evaluated under or over 24 months of age. Among children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were at risk of development delay. For children without microcephaly, the percentages found to be at risk of developmental delays were markedly lower and did not differ by prenatal ZIKV exposure status: Groups 3, 13.8%; Group 4, 21.7%. Conclusions: Among groups of children with prenatal ZIKV exposure, we found a gradient of risk of development delay. Children with severe microcephaly were at highest risk, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.