scholarly journals Neurodevelopment in normocephalic children with and without prenatal Zika virus exposure

2021 ◽  
pp. archdischild-2020-321031
Author(s):  
Karen Blackmon ◽  
Roberta Evans ◽  
Michelle Fernandes ◽  
Barbara Landon ◽  
Trevor Noel ◽  
...  
Keyword(s):  
Zika Virus ◽  
Maternal Serum ◽  
Group Differences ◽  
Control Group ◽  
Laboratory Assessment ◽  
Neurodevelopmental Outcomes ◽  
Child Exposure ◽  
Virus Exposure ◽  
Parallel Control ◽  
Normal Head

ObjectiveZika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.DesignCohort study.SettingPublic health centres in Grenada, West Indies.Patients384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measuresThe INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.ResultsA total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.ConclusionsOverall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.

scholarly journals Examining the Association of Socioeconomic Position with Microcephaly and Delayed Childhood Neurodevelopment among Children with Prenatal Zika Virus Exposure

Viruses ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1342
Author(s):  
Grace M. Power ◽  
Suzanna C. Francis ◽  
Nuria Sanchez Clemente ◽  
Zilton Vasconcelos ◽  
Patricia Brasil ◽  
...  
Keyword(s):  
Socioeconomic Position ◽  
Zika Virus ◽  
Early Life ◽  
Regression Models ◽  
Social Protection ◽  
Socioeconomic Indicators ◽  
Linear Regression Models ◽  
Neurodevelopmental Outcomes ◽  
Individual Level ◽  
Virus Exposure

Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.

scholarly journals Developmental outcomes in children exposed to Zika virus in utero from a Brazilian urban slum cohort study

2021 ◽  
Vol 15 (2) ◽  
pp. e0009162
Author(s):  
Juan P. Aguilar Ticona ◽  
Nivison Nery ◽  
Joseph B. Ladines-Lim ◽  
Claudia Gambrah ◽  
Gielson Sacramento ◽  
...  
Keyword(s):  
Zika Virus ◽  
Significant Proportion ◽  
Population Attributable Fraction ◽  
Urban Slum ◽  
Population Based ◽  
In Utero ◽  
Control Group ◽  
Neurodevelopmental Outcomes ◽  
Cognitive Delay ◽  
Increased Risk

Background The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV) exposure in children is not well understood. Furthermore, estimation of the Population Attributable Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed due to lack of population-based cohorts with data on symptomatic and asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV exposure. Methodology/Principal findings We performed a cohort of biannual community-based prospective serosurveys in a slum community in Salvador, Brazil. We recruited women participating in our cohort, with a documented pregnancy from January 2015 to December 2016 and children born to those mothers. Children were classified as ZIKV exposed in utero (born from women with ZIKV seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric, ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At 11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive delay (RR 5.1; 95%CI 1.1–24.4) compared with the 33 children unexposed, with a PAF of 53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%CI 1.3–26.9), with a PAF of 59.5%. Conclusions A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay and auditory behavioral abnormalities even in the absence of gross birth defects such as microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest that over half of these abnormalities could be attributed to intrauterine ZIKV exposure.

Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure

2021 ◽  
Author(s):  
Marcela Daza ◽  
Marcela Mercado ◽  
Cynthia A. Moore ◽  
Diana Valencia ◽  
Maria Fernanda Lengua ◽  
...  
Keyword(s):  
Brain Imaging ◽  
Zika Virus ◽  
Imaging Studies ◽  
Neurodevelopmental Outcomes ◽  
Virus Exposure

EXPRESS: Altering the rehabilitation environment to improve stroke survivor activity (AREISSA): a Phase II trial.

2021 ◽  
pp. 174749302110069
Author(s):  
Heidi Janssen ◽  
Louise Ada ◽  
Sandy Middleton ◽  
Michael Pollack ◽  
Michael Nilsson ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Environmental Enrichment ◽  
Brain Plasticity ◽  
Social Activity ◽  
Stroke Survivor ◽  
Group Differences ◽  
Control Group ◽  
Serious Adverse Events ◽  
Clinical Trial Registration

Background: Environmental enrichment involves organisation of the environment and provision of equipment to facilitate engagement in physical, cognitive and social activity. In animals with stroke, it promotes brain plasticity and recovery. Aims: To assess the feasibility and safety of a patient-driven model of environmental enrichment incorporating access to communal and individual environmental enrichment. Methods: A non-randomised cluster trial with blinded measurement involving people with stroke (n=193) in 4 rehabilitation units was carried out. Feasibility was operationalised as activity 10 days after admission to rehabilitation and availability of environmental enrichment. Safety was measured as falls and serious adverse events. Benefit was measured as clinical outcomes at 3 months, by an assessor blinded to group. Results: The experimental group (n=91) spent 7% (95% CI -14 to 0) less time inactive, 9% (95% CI 0 to 19) more time physically, and 6% (95% CI 2 to 10) more time socially active than the control group (n=102). Communal environmental enrichment was available 100% of the time, but individual environmental enrichment was rarely within reach (24%) or sight (39%). There were no between-group differences in serious adverse events or falls at discharge or 3 months nor in clinical outcomes at 3 months. Conclusions: This patient-driven model of environmental enrichment was feasible and safe. However, the very modest increase in activity by people with stroke, and the lack of benefit in clinical outcomes 3 months after stroke do not provide justification for an efficacy trial. Clinical Trial Registration: ANZCTR 12613000796785 Words: 245

Is ProBNP a New Marker for Predicting Intrauterine Growth Restriction?

2021 ◽  
Vol 225 (02) ◽  
pp. 125-128
Author(s):  
Hasan Eroğlu ◽  
Nazan Vanlı Tonyalı ◽  
Gokcen Orgul ◽  
Derya Biriken ◽  
Aykan Yucel ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Final Analysis ◽  
First Trimester ◽  
Maternal Serum ◽  
Growth Restriction ◽  
Control Group ◽  
Aneuploidy Screening ◽  
Intrauterine Growth ◽  
Potential Marker ◽  
The Mean

Abstract Purpose To evaluate the usability of first-trimester maternal serum ProBNP levels in the prediction of intrauterine growth restriction (IUGR). Methods In this prospective study, blood samples taken from 500 women who applied to our polyclinic for routine serum aneuploidy screening between the 11–14th gestational weeks were centrifuged. The obtained plasma samples were placed in Eppendorf tubes and stored at −80+°C. For the final analysis, first-trimester maternal serum ProBNP levels of 32 women diagnosed with postpartum IUGR and 32 healthy women randomly selected as the control group were compared. FGR was defined as estimated fetal weight below the 10th percentile for the gestational age. Results The mean ProBNP levels were statistically and significantly higher in the women with intrauterine growth restriction (113.73±94.69 vs. 58.33±47.70 pg/mL, p<0.01). At a cut-off level of 50.93, ProBNP accurately predicted occurrence of IUGR (AUC+= 0.794 (95% confidence interval 0.679–0.910), p+= 0.001) with sensitivity and specificity rates of 78.1 and 69.0%, respectively. Conclusion First-trimester serum ProBNP level was significantly higher in women who developed IUGR compared to healthy controls. First-trimester ProBNP level can be used as a potential marker to predict the development of IUGR in pregnant women.

scholarly journals Impact of Maternal Daily Oral Low-Dose Vitamin A Supplementation on the Mother–Infant Pair: A Randomised Placebo-Controlled Trial in China

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2370
Author(s):  
Ye Ding ◽  
Ping Hu ◽  
Yue Yang ◽  
Fangping Xu ◽  
Fang Li ◽  
...  
Keyword(s):  
Health Status ◽  
Breast Milk ◽  
Vitamin A ◽  
Low Dose ◽  
Maternal Serum ◽  
Control Group ◽  
Vitamin A Supplementation ◽  
Maternal Vitamin ◽  
Vitamin A Status ◽  
Lactating Mothers

Background: The nutritional status of vitamin A in lactating mothers and infants is still not optimistic. Due to the dietary habits and dietary restrictions of postpartum customs in China, vitamin A supplementation has been advocated as a potential strategy to improve vitamin A status of lactating mothers with inadequate dietary vitamin A intake. Existing clinical trials are limited to single or double high-dose maternal administrations. However, in China, vitamin A supplements are readily available in the form of daily oral low-dose supplements, and the effect of these is unknown. This study aimed to evaluate the effects of daily oral low-dose vitamin A supplementation on the retinol levels in the serum and breast milk of lactating mothers and the health status of infants in China. Methods: Lactating mothers who met the inclusion criteria and planned to continue exclusive breastfeeding were randomly assigned to receive either daily oral vitamin A and D drops (one soft capsule of 1800 IU vitamin A and 600 IU vitamin D2), or a matching placebo for 2 months. Before and after the intervention, dietary intake was investigated by instant photography, and the retinol concentration in maternal serum and breast milk was determined by ultra-high performance liquid chromatography-tandem mass spectrometry. During the trial, the health status of infants was diagnosed by a paediatrician or reported by lactating mothers. A total of 245 participants completed the study, with 117 in the supplementation group and 128 in the control group. Results: After the 2-month intervention, maternal serum retinol concentrations increased in the supplementation group with no change in the control group. Although breast milk retinol concentrations decreased significantly in both groups, the decrease in the supplementation group was significantly lower than that in the control group. However, maternal vitamin A supplementation was not associated with a lower risk of infant febrile illness, respiratory tract infection, diarrhoea, and eczema. Conclusions: Daily oral low-dose vitamin A supplementation is helpful in improving maternal vitamin A status, despite having no effect on infant health status through breast milk.

scholarly journals Molecular mechanisms of Zika virus teratogenesis from animal studies: a systematic review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gabriela Elis Wachholz ◽  
Julia do Amaral Gomes ◽  
Juliano André Boquett ◽  
Fernanda Sales Luiz Vianna ◽  
Lavínia Schuler-Faccini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Animal Models ◽  
Zika Virus ◽  
Methodological Quality ◽  
Molecular Mechanisms ◽  
Grey Literature ◽  
Standard Form ◽  
Teratogenic Effect ◽  
Control Group

Abstract Background Due to the diversity of studies in animal models reporting that molecular mechanisms are involved in the teratogenic effect of the Zika virus (ZIKV), the objective of the present study is to evaluate the methodological quality of these studies, as well as to demonstrate which genes and which molecular pathways are affected by ZIKV in different animal models. Methods This search will be performed in four databases: PubMed/MEDLINE, EMBASE, Web of Science, and Scopus, as well as in the grey literature. The studies selection process will be reported through the PRISMA Statement diagram model. All studies describing the molecular mechanisms possibly involved in the development of malformations caused by embryonic/fetal ZIKV exposure in animal models with an appropriate control group and methodology will be included (including, for instance, randomized and non-randomized studies). All animals used as experimental models for ZIKV teratogenesis may be included as long as exposure to the virus occurred during the embryonic/fetal period. From the selected studies, data will be extracted using a previously prepared standard form. Bias risk evaluation will be conducted following the SYRCLE’s Risk of Bias tool. All data obtained will be tabulated and organized by outcomes (morphological and molecular). Discussion With the proposed systematic review, we expect to present results about the methodological quality of the published studies with animal models that investigated the molecular mechanisms involved in the teratogenic effect of ZIKV, as well as to show the studies with greater reliability. Systematic review registration PROSPERO CRD42019157316

scholarly journals Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD

2021 ◽  
Vol 18 (8) ◽  
pp. 4207
Author(s):  
Jose L. Gonzalez-Montesinos ◽  
Jorge R. Fernandez-Santos ◽  
Carmen Vaz-Pardal ◽  
Jesus G. Ponce-Gonzalez ◽  
Alberto Marin-Galindo ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Rehabilitation Programme ◽  
Group Differences ◽  
Control Group ◽  
Chronic Obstructive ◽  
Maximum Value ◽  
Copd Patients ◽  
Significant Difference ◽  
Pulmonary Rehabilitation Programme ◽  
Positive Increment

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = −435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, −8.5 L/min, BF10 = 25), respiratory rate (RR, −3.3 breaths/min, BF10 = 2), heart rate (HR, −13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, −183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, −3.8 L/min, BF10 = 1.1) and compared to CG in VE (−8.3 L/min, BF10 = 3.6), VCO2 (−215.9 L/min, BF10 = 3.0), EqCO2 (−3.7 L/min, BF10 = 1.1) and HR (−12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (−4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

Short- and long-term outcomes of preterm spontaneous twin anemia-polycythemia sequence

2020 ◽  
Vol 48 (4) ◽  
pp. 329-334
Author(s):  
Soo Jin Han ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Subeen Hong ◽  
Jeong Won Oh ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Control Group ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Monochorionic Twin ◽  
Increased Risk ◽  
Study Population

AbstractBackgroundIn monochorionic twin pregnancy, placental anastomosis and inter-twin blood transfusion can result in specific complications, such as twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS). It is well established that adverse outcomes are increased in TTTS, but reports on the neonatal and long-term outcomes of TAPS are lacking. The objective of this study was to evaluate the neonatal and neurodevelopmental outcomes in spontaneous TAPS.MethodsThe study population consisted of monochorionic twin pregnancies with preterm birth (24–37 weeks of gestation) between November 2003 and December 2016 and in which cord blood was taken at the time of delivery. According to the result of hemoglobin in cord blood, the study population was divided into two groups: a spontaneous TAPS group and a control group. Neonatal and neurodevelopmental outcomes were compared between the two groups.ResultsDuring the study period, 11 cases were diagnosed as spontaneous TAPS (6.4%). The TAPS group had lower gestational age at delivery and had a higher risk for cesarean delivery. However, neonates with TAPS were not at an increased risk for neonatal mortality and significant neonatal morbidity. In addition, the frequency of severe cerebral lesion during the neonatal period and the risk of cerebral palsy at 2 years of age were not different between the two groups.ConclusionThe spontaneous TAPS diagnosed by postnatal diagnostic criteria was not associated with the increased risk of adverse neonatal and neurodevelopmental outcomes. Further studies are needed to evaluate the morbidity of antenatally diagnosed TAPS.

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