Clinical characteristics of children with congenital Zika syndrome: a case series.

BACKGROUND: The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns. OBJECTIVE: This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores. METHODS: Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T. RESULTS: The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control. DISCUSSION: Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.

Clinical characteristics of children with congenital Zika syndrome: a case series / Características clínicas de crianças com síndrome do zika congênita: uma série de casos

ABSTRACT Background: The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns. Objective: This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores. Methods: Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T. Results: The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control. Discussion: Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.

RESUMO Introdução: A síndrome congênita do zika envolve alterações estruturais do cérebro, incluindo ventriculomegalia, córtices finos do cérebro, padrão giral anormal, malformações corticais, hipoplasia do corpo caloso, atraso de mielinização, calcificações difusas subcorticais, hipoplasia do tronco cerebral e microcefalia em recém-nascidos. Objetivo: Este estudo teve como objetivo descrever as características clínicas de crianças com síndrome congênita do zika; comparar os resultados de bebês infectados no primeiro (1T, n=20) e no segundo trimestres da gravidez (2T, n=11); investigar correlações entre peso ao nascer, perímetro cefálico ao nascer e acompanhamento, idade gestacional ao nascer e escores motores brutos. Método: Os participantes foram avaliados com a Escala Motora Infantil de Alberta (Alberta Infant Motor Scale - AIMS) e a parte A da Medida da Função Motora Grossa (Gross Motor Function Measure - GMFM-A). A ANOVA comparou a circunferência da cabeça, a idade gestacional ao nascer, o peso ao nascer e o desempenho motor bruto de 1T e 2T. As correlações foram investigadas pelos coeficientes de correlação de Pearson. A ANOVA mostrou diferenças no perímetro cefálico ao nascimento e acompanhamento. A circunferência da cabeça foi menor no 1T, em comparação ao 2T. Resultados: O desempenho motor foi classificado como abaixo do quinto percentil na AIMS para todas as crianças e o 1T apresentou escores mais baixos na posição de bruços, sentado e no escore total da AIMS, em comparação ao 2T. As crianças variaram de 8 a 78% no GMFM-A e houve um desempenho motor pior de 1T. Dezenove crianças apresentaram hipertonia, seis apresentaram tônus normal e seis apresentaram hipotonia. A circunferência da cabeça no nascimento foi correlacionada com o controle postural em posição de bruços à AIMS. Discussão: O perímetro cefálico de acompanhamento foi correlacionado aos escores AIMS em posição de bruços, em supino e no escore total. Menor perímetro cefálico ao nascimento e acompanhamento indicaram pior controle postural. Crianças com síndrome congênita do zika apresentaram microcefalia ao nascimento e acompanhamento. Circunferências da cabeça menores e piores resultados motores foram observados no 1T. Os bebês apresentaram maus resultados visuais e motores. Foram encontradas correlações moderadas positivas entre o nascimento e a circunferência da cabeça de acompanhamento, e a função motora grossa.