High-risk children and social isolation: the importance of family functioning.

High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.

Language delay was associated with a smaller head circumference at birth in asymptomatic infants prenatally exposed to the Zika virus.

AIM: Our aim was to analyse 12-month outcomes of children who were prenatally exposed to the Zika virus and asymptomatic at birth. METHODS: This was an observational, exploratory study of infants exposed to the Zika virus during gestation and born between March 2016 and April 2017 without congenital Zika syndrome. They were followed until the age of 22 months. The outcome measure was neurodevelopment at 12 months of life, which was evaluated with the Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III). The scores were adjusted for maternal education and prematurity. RESULTS: A total of 96 infants were included in the study and 35.4% scored below the normal range in at least one Bayley-III domain. The majority (91.2%) of the infants with delayed scores presented with language delay, which was not associated with the gestational age at exposure. Receptive language was more affected by exposure than expressive language (27.0% vs 19.8%). There was a direct, and significant, association between the head circumference Z-score at birth and language delay. CONCLUSION: Language delay was associated with a smaller head circumference at birth in infants prenatally exposed to the Zika virus and born asymptomatic. This may indicate future learning difficulties.

Neurodevelopment of children exposed intra-uterus by Zika virus: A case series.

The main goal of this manuscript was to investigate the neurodevelopment of children exposed by Zika virus in the intrauterine period who are asymptomatic at birth. Newborns with documented Zika virus exposure during the intrauterine period who were asymptomatic at birth were followed in the first two years of life for neurodevelopment using Bayley III test. Children were classified as having normal or delayed neurodevelopment for age based on most recent Bayley III evaluation results. Eighty-four infants were included in the study. The first Bayley III evaluation was performed at a mean chronological age of 9.7±3.1 month; 13 children (15%) had a delay in one of the three domains, distributed as follow: 10 (12%) in the language domain and 3 (3.5%) in the motor domain. The most recent Bayley III evaluation was performed at a mean age 15.3±3.1 months; 42 children (50%) had a delay in one of the three domains: 4 (5%) in cognition, 31 (37%) in language, and 20 (24%) in motor performance. There were no statistical differences in Gender, Gestational Age, Birth Weight and Head Circurference at birth between children with normal and delayed neurodevelopment for age. A very high proportion of children exposed ZIKV during pregnancy who were asymptomatic at birth demonstrated a delay in neurodevelopment, mainly in the language domain, the first two years of life.