Acquired Hip Dysplasia in Children with Congenital Zika Virus Infection in the First Four Years of Life.

Acquired hip dysplasia has been described in children with cerebral palsy (CP); periodic surveillance is recommended in this population to prevent hip displacement and dislocation. Children with congenital zika syndrome (CZS) may present a spectrum of neurological impairments with changes in tonus, posture, and movement similar to children with CP. However, the relationship between CZS and hip dysplasia has not been characterized. In this prospective cohort study, we aimed to describe the occurrence of hip dysplasia in patients with CZS. Sixty-four children with CZS from 6 to 48 months of age were included and followed at a tertiary referral center in Rio de Janeiro, Brazil, with periodic radiologic and clinical hip assessments. Twenty-six (41%) patients were diagnosed with hip dysplasia during follow-up; mean age at diagnosis was 23 months. According to the Gross Motor Function Classification System (GMFCS), 58 (91%) patients had severe impairment (GMFCS IV and V) at the first evaluation. All patients with progression to hip dysplasia had microcephaly and were classified as GMFCS IV or V. Pain and functional limitation were reported by 22 (84%) caregivers of children with hip dysplasia. All patients were referred to specialized orthopedic care; eight (31%) underwent surgical treatment during follow-up. Our findings highlight the importance of implementing a hip surveillance program and improving access to orthopedic treatment for children with CZS in order to decrease the chances of dysplasia-related complications and improve quality of life.

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life.

Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.

24-hour Holter findings in infants with in-utero exposure to the Zika virus: a series of cases.

Severe neurological problems and other special manifestations such as high prevalence of structural cardiac changes has been described in infants vertically exposed to the Zika virus (ZIKV) and has been called congenital Zika virus syndrome (CZS). Previous studies have shown that the 24-hour Holter heart rate variability (HRV) analysis allows the prediction of worse outcomes in infants with neurological impairment and higher risk of sudden infant death syndrome (SIDS), hypertension, diabetes mellitus and other cardiovascular diseases. This study describes the 24-hour Holter findings of infants with confirmed vertical exposure to the ZIKV by positive polymerase chain reaction (PCR) assays in the mother's blood during pregnancy and/or in the urine or cerebrospinal fluid of the newborn. Data analysis was descriptive and included two subgroups according to the presence of fetal distress, positive PCR to ZIKV in the newborn, CZS and severe microcephaly. Heart rate, pauses, arrhythmias, ST segment and QT interval analyses and HRV evaluation through R-R, SDNN, pNN50 and rMMSD were described. The Mann-Whitney test was performed to assess differences between the two subgroups. The sample consisted of 15 infants with a mean age of 16 months, nine of whom were male. No arrhythmias or QT interval changes were observed. The comparison of HRV through the Mann-Whitney test showed a significant difference between patients with and without CZS, with and without severe microcephaly, with lower HRV in the groups with severe microcephaly and CZS. The study suggests that there is an increased risk of SIDS and cardiovascular diseases in this group of patients.

Early Clinical Infancy Outcomes for Microcephaly and/or SGA Zika-exposed Infants

Antecedentes: bebês expostos ao zika com microcefalia (proporcional ou desproporcional) e aqueles que são pequenos para a idade gestacional sem microcefalia devem ser acompanhados de perto, principalmente suas trajetórias de crescimento. Eles apresentam alto risco de resultados adversos no primeiro ano de vida. A exposição pré-natal ao vírus Zika (ZIKV) pode levar a resultados adversos no bebê, incluindo microcefalia e ser pequena para a idade gestacional (PIG). Bebês expostos ao ZIKV com diagnóstico de microcefalia (proporcional [PM] ou desproporcional [DM]) ou PIG ao nascimento foram avaliados com medidas antropométricas e resultados de saúde. Métodos: Os bebês tiveram exposição ao ZIKV confirmada laboratorialmente no Brasil. A classificação PM, DM ou SGA foi baseada na circunferência da cabeça e peso. Os parâmetros de crescimento do primeiro ano e os resultados clínicos foram registrados com as análises realizadas. Resultados: Entre as 156 crianças expostas ao ZIKV, 14 (9,0%) eram ASG, 13 (8,3%) PM, 13 (8,3%) DM e 116 (74,4%) não eram ASG nem tinham microcefalia (NSNM). Altas taxas de anormalidades neurológicas, oftalmológicas e auditivas foram observadas para PM (100%), DM (100%) e PIG (42,9%) vs RNMN (18,3%; P <0,001); odds ratio [OR], 3,4 (intervalo de confiança de 95% [IC], 1,1-10,7) para SGA vs NSNM. Anormalidades de neuroimagem foram observadas em 100% dos PM e DM e em 42,9% dos PIG vs NSNM 16%; (P <0,001); OR 3,9 (IC 95%, 1,2-12,8) para ASG vs NSNM. As taxas de crescimento pelo escore z, particularmente para bebês com microcefalia, foram ruins após o nascimento, mas apresentaram melhora após os quatro meses de vida. Conclusões: Lactentes expostos ao ZIKV com microcefalia (MP e DM) apresentaram taxas igualmente altas de resultados adversos, mas mostraram melhora nas medidas de crescimento além dos 4 meses de vida. Enquanto os bebês SGA tiveram menos resultados adversos em comparação aos bebês com microcefalia, foram observados resultados adversos notáveis ​​em alguns; as chances de ter resultados adversos eram 3 a 4 vezes maiores em comparação aos RNMN.Lindos bebês expostos ao zika com microcefalia, independentemente de serem proporcionais ou desproporcionais, e aqueles que são pequenos para a idade gestacional sem microcefalia devem ser acompanhados de perto, particularmente suas trajetórias de crescimento . Eles apresentam alto risco de resultados adversos no primeiro ano de vida.