Harnessing the power of telemedicine to accomplish international pediatric outcome research during the COVID-19 pandemic

The COVID-19 pandemic occurred during planned neurodevelopmental follow-up of Colombian children with antenatal Zika-virus exposure. The objective of the study was to leverage the institution's telemedicine infrastructure to support international clinical child outcome research. In a prospective cohort study of child neurodevelopment (NCT04398901), we used synchronous telemedicine to remotely train a research team and perform live observational assessments of children in Sabanalarga, Colombia. An observational motor and conceptional standardized tool kit was mailed to Colombia; other materials were translated and emailed; team training was done virtually. Children were recruited by team on the ground. Synchronous activities were video-recorded directly to two laptops, each with a telehealth Zoom link to allow simultaneous evaluation of “table” and “standing” activities, and backup recordings were captured directly on the device in Colombia. The U.S. team attended live over Zoom from four states and five distinct locations, made observational notes, and provided real-time feedback. Fifty-seven, 3–4-year-old children with Zika-virus exposure and 70 non-exposed controls were studied during 10 daytrips. Direct laptop recording ensured complete record of child activities due to internet outages. Telemedicine can be used to successfully perform international neurodevelopmental outcome research in children during the COVID-19 pandemic. Telemedicine can benefit global health studies.

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Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz629 ◽

2019 ◽

Vol 221 (11) ◽

pp. 1838-1845 ◽

Cited By ~ 1

Author(s):

Nasim C Sobhani ◽

Elyzabeth Avvad-Portari ◽

Aline C M Nascimento ◽

Heloisa N Machado ◽

Daniel S S Lobato ◽

...

Keyword(s):

Zika Virus ◽

Prospective Cohort ◽

Neonatal Outcome ◽

Infant Outcomes ◽

Long Term Follow Up ◽

History Of ◽

Virus Exposure ◽

Twin Pregnancies

Abstract Background There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. Methods This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. Results Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16–33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. Conclusions Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.

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Childhood neurodevelopmental outcome in low birth weight infants with postligation cardiac syndrome after ductus arteriosus closure: 5-years follow up

10.26226/morressier.57d034ced462b80292382f3b ◽

2016 ◽

Author(s):

Maria Carmen BRAVO

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Ductus Arteriosus ◽

Neurodevelopmental Outcome ◽

Low Birth Weight Infants ◽

Cardiac Syndrome

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Faculty Opinions recommendation of Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure--United States, 2016.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726257412.793521430 ◽

2016 ◽

Author(s):

Mari-Paule Thiet

Keyword(s):

United States ◽

Health Care ◽

Health Care Providers ◽

Zika Virus ◽

Reproductive Age ◽

Care Providers ◽

Women Of Reproductive Age ◽

Virus Exposure

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Faculty Opinions recommendation of Behavioral and neurodevelopmental outcome of children after maternal allopurinol administration during suspected fetal hypoxia: 5-year follow up of the ALLO-trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733857810.793567679 ◽

2019 ◽

Author(s):

Michael Johnston

Keyword(s):

Neurodevelopmental Outcome ◽

Fetal Hypoxia

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Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

Journal of Pediatric Neurology ◽

10.1055/s-0040-1708496 ◽

2020 ◽

Author(s):

Arti Maria ◽

Tapas Bandyopadhyay

Keyword(s):

Cerebrospinal Fluid ◽

Neurodevelopmental Outcome ◽

Neurological Sequelae ◽

Glucose Levels ◽

Csf Analysis ◽

First Case ◽

Time Of Admission ◽

Cerebrospinal Fluid Protein ◽

Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

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Complications and Sequelae in Patients With Congenital Microcephaly Associated With Zika Virus Infection: Two-Year Follow-Up

Journal of Child Neurology ◽

10.1177/0883073820983163 ◽

2021 ◽

pp. 088307382098316

Author(s):

Luane A. Gouvea ◽

Marlos Martins ◽

Daniela Vivacqua ◽

Julia Rosseto ◽

Giulia Lima ◽

...

Keyword(s):

Developmental Delay ◽

Zika Virus ◽

Median Number ◽

Global Developmental Delay ◽

Spastic Diplegia ◽

Long Term Follow Up ◽

Congenital Microcephaly ◽

Auditory Impairment ◽

Worse Prognosis

Background: We aim to describe the long term follow-up of a cohort of children exposed in utero to the Zika virus. Methods: Descriptive study of a cohort of microcephalic children due to Zika virus. Logistic regression was used to evaluate variables associated with worse prognosis epilepsy. Results: We followed 28 children (15 females), with a median follow-up of 24 months (IQR = 12-28). During the follow-up, 1 infant died. The median head circumference at birth was 29 cm (IQR = 27-31). All presented a global developmental delay. The most frequent central nervous system abnormalities were on cortical development in 22 participants; dysgenesis of corpus callosum in 13; ventriculomegaly in 25; and calcifications in 24. A total of 9 presented ocular abnormalities, 4 auditory impairment. During follow-up, 12 presented with sleep disorders, 10 with irritability, and 23 with epilepsy (2 with generalized tonic-clonic, 3 with generalized tonic-clonic and spasms, 12 with spasms, 3 tonic and spasms, and 3 motor focal and spasms). The median age at the begin of the epilepsy was 4 months (IQR = 2-10), the median number of drugs used to control the epilepsy was 2 (IQR = 2-3). Maternal illicit drug use during pregnancy was associated with worse prognosis epilepsy (Lennox-Gastaut syndrome, West syndrome, or status epilepticus). A total of 19 presented with dysphagia, 10 children required gastrostomy. Conclusion: Children with microcephaly due to Zika virus presented with several complications during follow-up, as epilepsy, spastic diplegia, and global developmental delay.

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