Predictors of Neurodevelopment in Microcephaly Associated with Congenital Zika Syndrome: A Prospective Study.

The municipality of Salvador, situated in Brazil, distinguished itself as the epicenter of the emergence of microcephaly related to congenital manifestations of Zika syndrome. Despite the anticipated significant developmental setbacks in these children, research has indicated a varied range of outcomes, with certain instances even reflecting minimal developmental delay. Our objective was to pinpoint determinants that could forecast developmental anomalies in children diagnosed with microcephaly associated with congenital Zika syndrome (CZS). METHODOLOGY: A forward-looking clinical and neurodevelopmental examination was conducted focusing on neonates diagnosed with microcephaly with CZS, birthed between September 2015 and April 2016 at the Hospital Geral Roberto Santos, in Salvador city. That infants were monitored up to their third year by a multiprofessional team. Child development was assessed using the composite Bayley III score. Undertaken by two blinded experts, cranial CT scan analysis was performed during the neonate period for the detection of brain abnormalities and to quantify ventricle enlargement, measured by Evans' index (EI). RESULTS: Fifty newborns were evaluated with a median head circumference of 28 cm (interquartile range 27-31 cm). EI was associated with neurodevelopmental delay at three years and remained significant after adjustment for head circumference. A 0.1-point increase in EI was associated with a delay of 3.2 months in the receptive language (p = 0.016), 3.4 months in the expressive language (p = 0.016), 3.4 months in the cognitive (p = 0.016), 2.37 months in the gross motor (p = 0.026), and 3.1 months in the fine motor (p = 0.021) domains. CONCLUSIONS: EI predicted neurodevelopmental delay in all Bayley domains in children with microcephaly associated with CZS.

Validation of the qCO cardiac output monitor during Valsalva maneuver.

Monitoring cardiac output for a variety of patient conditions is essential to ensure tissue perfusion and oxygenation. Cardiac output can be measured either invasively using a pulmonary artery catheter or non-invasively using impedance cardiography (ICG). The objective of the present study was to validate a cardiac output monitor, the qCO (Quantium Medical, Barcelona, Spain). The qCO is based on the ICG principle. Twenty-five volunteers (18-75 years) were enrolled in the study. The duration of the study was 10 min. The subjects were asked to rest quietly in an armchair for a duration of 5 min. At 5 min they were asked to do a Valsalva maneuver which is known to decrease the cardiac output. The baseline value of the normalized cardiac output (qCO index) was compared with the minimum value during the Valsalva maneuver. The results showed (t-test, p<0.0005) significant difference between the cardiac output estimated at baseline and during the Valsalva maneuver. In conclusion, the qCO was able to indicate trend changes of the cardiac output in volunteers.