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.

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model.

Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80−94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains.

Longitudinal Follow-Up of Gross Motor Function in Children with Congenital Zika Virus Syndrome from a Cohort in Rio de Janeiro, Brazil.

Knowledge of how congenital Zika syndrome (CZS) impacts motor development of children longitudinally is important to guide management. The objective of the present study was to describe the evolution of gross motor function in children with CZS in a Rio de Janeiro hospital. In children with CZS without arthrogryposis or other congenital osteoarticular malformations who were followed in a prospective cohort study, motor performance was evaluated at two timepoints using the Gross Motor Function Classification System (GMFCS) and the Gross Motor Function Measurement test (GMFM-88). Among 74 children, at the baseline evaluation, the median age was 13 (8-24) months, and on follow-up, 28 (24-48) months. According to GMFCS at the second timepoint, 6 children were classified as mild, 11 as moderate, and 57 as severe. In the GMFM-88 assessment, children in the severe group had a median score of 10.05 in the baseline evaluation and a follow-up score of 12.40, the moderate group had median scores of 25.60 and 29.60, and the mild group had median scores of 82.60 and 91.00, respectively. Although a small developmental improvement was observed, the motor impairment of children was mainly consistent with severe cerebral palsy. Baseline motor function assessments were predictive of prognosis.

Gross motor function in children with Congenital Zika Syndrome from Rio de Janeiro, Brazil.

Congenital Zika Syndrome (CZS) is characterized by many impairments especially in the central nervous system, potentially compromising neurodevelopment and causing significant morbidity in affected children. The aim was to assess gross motor function in children with CZS. This was a cross-sectional investigation nested within a prospective cohort study of children with CZS based in a Brazilian referral hospital in Rio de Janeiro. Between March/2017 and February/2018, we performed gross motor function assessments using the Gross Motor Function Classification (GMFCS) and the Gross Motor Function Measure (GMFM), estimating the mean and standard deviation of GMFM scores among GMFCS groups. The study sample included 72 children, with a median age of 13 months (7-25). Of these, 63 (87.5%) had severe motor impairment, 3 (4%) had moderate impairment, and 6 (8%) had mild impairment. The mean GMFM score for each group was respectively 11.6, 26.1, and 81.6, with statistically significant differences (p-value < 0.001). Severely affected children only achieved head control in the sitting posture when supported. Children with milder forms were able to develop walking skills.Conclusion: Most children with CZS have major motor disabilities and a poor prognosis. Better understanding of limitations and functionality in children with CZS can serve as a prognostic guide in their management. What is Known: • Severe motor impairment was present in 63 (87.5%) children with CZS. • The degree of neurological impairment was inversely associated with motor performance. What is New: • Microcephaly was more frequent among children with severe gross motor function impairment. • Children with CZS have major motor disabilities and a poor prognosis.

Desenvolvimento motor grosso das crianças com Síndrome Congênita do Vírus Zika / Gross motor development of children with Zika Virus Congenital Syndrome

A criança com SCZ possui alterações de tônus e postura, porém seu impacto ao longo desenvolvimento motor ainda é desconhecido após três anos dessa síndrome. Assim, avaliar e compreender o seu desempenho motor longitudinalmente pode dimensionar as alterações motoras grossas decorrentes da doença e direcionar ações de política pública. Objetivo: Descrever a evolução do desenvolvimento motor grosso de crianças com SCZ, acompanhadas no ambulatório de doenças infecciosas pediátricas de um hospital de referência do Estado do Rio de Janeiro. Método: Estudo descritivo e prospectivo, pertencente a uma coorte, intitulada: "Exposição Vertical ao Vírus Zika e suas consequências no neurodesenvolvimento da criança". Foram avaliadas crianças com SCZ a partir de 7 meses de idade e excluídas crianças com artrogripose ou outras malformações osteoarticulares congênitas. A amostra foi classificada de acordo com o Sistema de Classificação da Função Motora Grossa (GMFCS) e avaliadas pelo teste de Medida de Função Motora Grossa (GMFM-88) em dois momentos, sendo a segunda avaliação após vinte e quatro meses (dois anos de idade no mínimo), desde que decorrido um prazo mínimo de doze meses entre a primeira e a segunda avaliação. Após a segunda avaliação, foram observados os Diamantes de Prognóstico Motor de Rosenbaum. Os dados foram analisados de maneira descritiva. Resultados: 74 crianças compuseram a amostra do estudo, na qual 52,1% (n=39) eram do gênero masculino, 43% (n=32) possuíam PCR + ZIKV, 73% (n=54) tinham microcefalia, e a maior parte, ou seja, 55,4% (n=41) foram expostas durante o 1° trimestre. Na avaliação inicial, a idade mediana foi de 13 (8-24) meses, e na final de 28 (24-28) meses. Seis crianças foram classificadas como leve (GMFCS I ou II), 11 como moderada (GMFCS III) e 57 como grave (GMFCS IV ou V). Com relação ao GMFM-88, o grupo grave obteve mediana de escore total inicial de 10,05 e final de 12,40, o grupo moderado mudou de 25,60 para 29,60, e o grupo leve passou de 82,60 para 91,00. Observada uma associação forte, negativa e estatisticamente significativa entre os grupos de GMFCS e os escore do GMFM ­ 88 da avaliação final (-0,732; p<0,001). O diamante A (sentar- se com apoio) e B (sentar-se se com braços livres por 3 segundos) foram alcançados por todo o grupo moderado e leve, mas por nem toda a amostra do grupo grave. O diamante C (andar 10 passos para frente sem apoio) foi alcançado por parte da amostra do grupo leve. Nenhuma criança pontuou no Diamante D (descer 4 degraus de escada alternando os pés e com as mãos livres). Conclusão: O comprometimento motor das crianças da pesquisa foi na sua maioria compatível com crianças com Paralisia Cerebral (PC) grave: apenas 5 crianças que alcançaram a marcha independente após 24 meses. Existe uma relação inversa entre o GMFCS e o GMFM, no qual as crianças mais graves funcionalmente apresentavam um escore total menor. Foi possível entender que essas crianças com SCZ apresentam alterações importantes no que tange ao desenvolvimento neurosensóriomotor, impondo uma vida com condições crônicas complexas de saúde. Assim, a partir dos resultados deste estudo pode-se direcionar melhor as intervenções terapêuticas e auxiliar a construção de diretrizes clínicas para esta população.

Introduction: Children with SCZ has changes in tone and posture but the syndrome's impact on motor development is still unknown after three years with it. Thus, assessing their motor performance longitudinally it's possible to measure the gross motor changes caused by the disease and orientate public policy actions on the matter. Objective: To describe the evolution of gross motor function in children with SCZ up at the pediatric ambulatory of infectious disease clinic from a reference hospital in the state of Rio de Janeiro. Method: Descriptive and prospective study belonging to a cohort entitled: "Vertical Exposure to Zika Virus and its consequences on the child's neurodevelopment". Children with SCZ from 7 months of age were evaluated and excluding children with arthrogryposis or other congenital osteoarticular malformations. The sample was classified according to the Gross Motor Function Classification System (GMFCS) and evaluated through the Gross Motor Function Measurement test (GMFM-88) in two distinctive moments, the second being after 24 months and with at least one year after the first one. After the last evaluation, the Diamonds of motor prediction were observed according to Rosenbaum. The data were analyzed in a descriptive manner. Results: 74 children compose the study sample. 52% (n = 39) were male, and 43% (n = 32) had CRP + ZIKV, 73% (n = 54) had microcephaly, and the most of it was exposed in the 1st trimester 55.4% (n = 41). In the initial evaluation, the average age was 13 (8-24) months, and in the final, 28 (24-28) months. Six children were classified as mild, 11 as moderate and 57 as severe, according to the GMFCS. According to the GMFM-88, the severe group obtained a median total score of 10.05 and a final of 12.40, the moderate group changed from 25.60 to 29.60, and the mild group went from 82, 60 to 91.00 A negative and statistically significant association was observed between the GMFCS groups and the GMFM - 88 scores from the final evaluation (-0.732; p = 0.000). Diamonds A (sitting with support) and B (sitting with free arms for 3 seconds) were achieved by the entire moderate and mild group, but not by the entire sample in the severe group. Diamond C (walking 10 steps forward without support) was achieved by the mild group sample. No child scored on the Diamond D (going down 4 steps with alternating feet and hands free). Conclusion: The motor impairment of the children in the study was mostly compatible with severe CP, we found only 5 children who reached gait after 24 months. There is a relation between GMFCS and GMFM, where the most functionally severe children had a lower total score. It was possible to understand that these children with SCZ present important changes regarding the neurosensory motor development, imposing a life with complex chronical health conditions. Thus, based on the results of this study, it is possible to better target therapeutic interventions and assist in the construction of clinical guidelines for this specific group.