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Gama G, Conceição Matias MD, de Luiz Vânia M, de Sales Regis T, Peregrino-Filho A, de Sales Tavares J, Amorim M, Melo A. Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome. Physiother Theory Pract 2024; 40:1362-1371. [PMID: 36625893 DOI: 10.1080/09593985.2023.2165887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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Affiliation(s)
- Gabriela Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
| | | | - Mell de Luiz Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
| | | | | | | | - Melania Amorim
- Instituto de Pesquisa Professor Jpaquim Amorim Neto and Instituto de Medicina Integral Professor Fernando Figueira
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
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Martens S, Maes L, Dhondt C, Vanaudenaerde S, Sucaet M, De Leenheer E, Van Hoecke H, Van Hecke R, Rombaut L, Dhooge I. Vestibular Infant Screening-Flanders: What is the Most Appropriate Vestibular Screening Tool in Hearing-Impaired Children? Ear Hear 2023; 44:385-398. [PMID: 36534644 DOI: 10.1097/aud.0000000000001290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES As children with sensorineural hearing loss have an increased risk for vestibular impairment, the Vestibular Infant Screening-Flanders project implemented a vestibular screening by means of cervical vestibular evoked myogenic potentials (cVEMP) at the age of 6 months for each child with hearing loss in Flanders (Belgium). Given that vestibular deficits can affect the child's development, this vestibular screening should allow early detection and intervention. However, less is currently known about which screening tool would be the most ideal and how vestibular impairment can evolve. Therefore, this study aimed to determine the most appropriate tool to screen for vestibular deficits, to assess the necessity of vestibular follow-up, and to set clinical guidelines for vestibular screening in children with hearing loss. DESIGN In total, 71 children with congenital or early-onset sensorineural hearing loss were enrolled (mean age at first appointment = 6.7 months). Follow-up was provided at 6 months, 1, 2, and 3 years of age. Below three years of age, the video Head Impulse Test (vHIT) of the horizontal semicircular canals (SCC), the cVEMP, and the rotatory test at 0.16, 0.04, and 0.01 Hz were applied. At 3 years of age, the vHIT of the vertical SCC and ocular vestibular evoked myogenic potentials (oVEMP) were added. To evaluate early motor development, the Alberta Infant Motor Scale (AIMS) results at 6 months and 1-year old were included. RESULTS At 6 months of age, the highest success rate was obtained with the cVEMP (90.0%) compared to the vHIT (70.0%) and the rotatory test (34.3-72.9%). Overall, vestibular deficits were found in 20.0% of the children, consisting of 13.9% with both SCC and otolith deficits (bilateral: 9.3%, unilateral: 4.6%), and 6.1% with unilateral isolated SCC (4.6%) or otolith (1.5%) deficits. Thus, vestibular deficits would not have been detected in 4.6% of the children by only using the cVEMP, whereas 1.5% would have been missed when only using the vHIT. Although vestibular deficits were more frequently found in severe to profound hearing loss (28.6%), characteristics of vestibular function were highly dependent on the underlying etiology. The AIMS results showed significantly weaker early motor development in children with bilateral vestibular deficits ( p = 0.001), but could not differentiate children with bilateral normal vestibular function from those with unilateral vestibular deficits ( p > 0.05). Progressive or delayed-onset vestibular dysfunction was only found in a few cases (age range: 12-36 months), in which the hearing loss was mainly caused by congenital cytomegalovirus (cCMV). CONCLUSIONS The cVEMP is the most feasible screening tool to assess vestibular function in 6-months-old children with hearing loss. Although the majority of children with vestibular deficits are detected with the cVEMP, the vHIT seems even more sensitive as isolated SCC deficits are associated with specific etiologies of hearing loss. As a result, the cVEMP is an appropriate vestibular screening tool, which is advised at least in severe to profound hearing loss, but certain etiologies require the addition of the vHIT (i.e., cCMV, meningitis, cochleovestibular anomalies with or without syndromic hearing loss).
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally to this work
| | - Leen Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- These authors contributed equally to this work
| | - Cleo Dhondt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Novelli M, Natale F, Di Norcia A, Boiani A, Temofonte S, Calandriello F, Zitarelli C, Caravale B. Early neurodevelopmental outcomes in children with asymptomatic congenital CMV infection. Ital J Pediatr 2022; 48:203. [PMID: 36572905 PMCID: PMC9793498 DOI: 10.1186/s13052-022-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/23/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Approximately 85-90% of congenital cytomegalovirus infections (cCMV) are asymptomatic. Few studies have investigated early and long-term neurodevelopmental outcomes in children with asymptomatic cCMV (acCMV), and the data is contradictory. In the present study, we did investigate the effect of cCMV asymptomatic infection on neurological outcomes and in cognitive, language and motor development at 6 months of age. METHODS Fifty-six children with cCMV asymptomatic infection were followed for 6 months, as part of a long-term surveillance program, examining their neurological and developmental outcomes. Neurological examination and Bayley-III Scales were performed. RESULTS Clinical evaluation revealed that early neurological outcomes were essentially normal, with minor neurological deficits (i.e., tone abnormalities) in a subgroup of patients. Bayley-III scores were substantially in the normal range, with 14% showing a score less than 85 (-1SD) in the Motor Scale. Children's neurological and neurodevelopmental outcomes at 6 months of age did not differ according to the trimester of infection. CONCLUSIONS Some infants with cCMV asymptomatic infection may present minor neurological abnormalities in early stages of life. It seems useful to monitor this population for early and late neurodevelopmental sequelae.
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Affiliation(s)
- Maria Novelli
- grid.7841.aDepartment of Human Neuroscience, Polyclinic Umberto I Hospital, Sapienza University, Via Dei Sabelli 108, 00185 Rome, Italy
| | - Fabio Natale
- grid.7841.aDepartment of Maternal and Child Sciences and Urology, Polyclinic Umberto I Hospital, Sapienza University, Rome, Italy
| | - Anna Di Norcia
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Arianna Boiani
- grid.7841.aDepartment of Human Neuroscience, Polyclinic Umberto I Hospital, Sapienza University, Via Dei Sabelli 108, 00185 Rome, Italy
| | - Sara Temofonte
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Francesca Calandriello
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy ,Centro NE.SVI, Rome, Italy
| | - Cristina Zitarelli
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Barbara Caravale
- grid.7841.aDepartment of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Shears A, Yan G, Mortimer H, Cross E, Sapuan S, Kadambari S, Luck S, Heath PT, Walter S, Fidler KJ. Vestibular and balance dysfunction in children with congenital CMV: a systematic review. Arch Dis Child Fetal Neonatal Ed 2022; 107:fetalneonatal-2021-323380. [PMID: 35545420 PMCID: PMC9606507 DOI: 10.1136/archdischild-2021-323380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities. DESIGN MEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. PATIENTS Children with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture). INTERVENTION Studies of vestibular function and/or balance assessments. MAIN OUTCOME MEASURES Vestibular function and balance. RESULTS 1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%-60%), than asymptomatic cCMV (0%-12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months. CONCLUSIONS Vestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case-controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions. PROSPERO REGISTRATION CRD42019131656.
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Affiliation(s)
- Annalie Shears
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Georgina Yan
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
- Department of Neonatology, University College London EGA Institute for Women's Health, London, UK
| | - Harriet Mortimer
- Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Elizabeth Cross
- Department of Infectious Diseases, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Shari Sapuan
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Seilesh Kadambari
- Department of Paediatrics, University of Oxford Oxford Vaccine Group, Oxford, Oxfordshire, UK
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | | | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Simone Walter
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Katy J Fidler
- Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
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Vestibular Function in Children With a Congenital Cytomegalovirus Infection: 3 Years of Follow-Up. ACTA ACUST UNITED AC 2021; 42:76-86. [DOI: 10.1097/aud.0000000000000904] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Walsh H, Zuwala J, Hunter J, Oh Y. Congenital Cytomegalovirus and Human Immunodeficiency Virus: Effects on Hearing, Speech and Language Development, and Clinical Outcomes in Children. Front Pediatr 2021; 9:771192. [PMID: 34976894 PMCID: PMC8716614 DOI: 10.3389/fped.2021.771192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Prenatal infections can have adverse effects on an infant's hearing, speech, and language development. Congenital cytomegalovirus (CMV) and human immunodeficiency virus (HIV) are two such infections that may lead to these complications, especially when left untreated. CMV is commonly associated with sensorineural hearing loss in children, and it can also be associated with anatomical abnormalities in the central nervous system responsible for speech, language, and intellectual acquisition. In terms of speech, language, and hearing, HIV is most associated with conductive and/or sensorineural hearing loss and expressive language deficits. Children born with these infections may benefit from cochlear implantation for severe to profound sensorineural hearing losses and/or speech therapy for speech/language deficits. CMV and HIV simultaneously present in infants has not been thoroughly studied, but one may hypothesize these speech, language, and hearing deficits to be present with potentially higher severity. Early identification of the infection in combination with early intervention strategies yields better results for these children than no identification or intervention. The purpose of this review was to investigate how congenital CMV and/or HIV may affect hearing, speech, and language development in children, and the importance of early identification for these populations.
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Affiliation(s)
- Hannah Walsh
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jillian Zuwala
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Jessica Hunter
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
| | - Yonghee Oh
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States
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Leruez-Ville M, Foulon I, Pass R, Ville Y. Cytomegalovirus infection during pregnancy: state of the science. Am J Obstet Gynecol 2020; 223:330-349. [PMID: 32105678 DOI: 10.1016/j.ajog.2020.02.018] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022]
Abstract
Cytomegalovirus is the most common congenital infection, affecting 0.5-2% of all live births and the main nongenetic cause of congenital sensorineural hearing loss and neurological damage. Congenital cytomegalovirus can follow maternal primary infection or nonprimary infection. Sensorineurological morbidity is confined to the first trimester with up to 40-50% of infected neonates developing sequelae after first-trimester primary infection. Serological testing before 14 weeks is critical to identify primary infection within 3 months around conception but is not informative in women already immune before pregnancy. In Europe and the United States, primary infection in the first trimester are mainly seen in young parous women with a previous child younger than 3 years. Congenital cytomegalovirus should be evoked on prenatal ultrasound when the fetus is small for gestation and shows echogenic bowel, effusions, or any cerebral anomaly. Although the sensitivity of routine ultrasound in predicting neonatal symptoms is around 25%, serial targeted ultrasound and magnetic resonance imaging of known infected fetuses show greater than 95% sensitivity for brain anomalies. Fetal diagnosis is done by amniocentesis from 17 weeks. Prevention consists of both parents avoiding contact with body fluids from infected individuals, especially toddlers, from before conception until 14 weeks. Candidate vaccines failed to provide more than 75% protection for >2 years in preventing cytomegalovirus infection. Medical therapies such as cytomegalovirus hyperimmune globulins aim to reduce the risk of vertical transmission but 2 randomized controlled trials have not found any benefit. Valaciclovir given from the diagnosis of primary infection up to amniocentesis decreased vertical transmission rates from 29.8% to 11.1% in the treatment group in a randomized controlled trial of 90 pregnant women. In a phase II open-label trial, oral valaciclovir (8 g/d) given to pregnant women with a mildly symptomatic fetus was associated with a higher chance of delivering an asymptomatic neonate (82%), compared with an untreated historical cohort (43%). Valganciclovir given to symptomatic neonates is likely to improve hearing and neurological symptoms, the extent of which and the duration of treatment are still debated. In conclusion, congenital cytomegalovirus infection is a public health challenge. In view of recent knowledge on diagnosis and pre- and postnatal management, health care providers should reevaluate screening programs in early pregnancy and at birth.
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Affiliation(s)
- Marianne Leruez-Ville
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malade, Laboratoire de Virologie, Centre National de Reference des Herpes Virus-Laboratoire Associé Infection Congénitale à Cytomégalovirus, Paris, France; EA Fetus, Paris Descartes Université, Université de Paris, Paris, France.
| | - Ina Foulon
- Department of Otolaryngology-Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; De Poolster Rehabilitation Centre, Brussels, Belgium
| | - Robert Pass
- Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Yves Ville
- EA Fetus, Paris Descartes Université, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malade, Maternité, Paris, France
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Nicloux M, Peterman L, Parodi M, Magny JF. Outcome and management of newborns with congenital cytomegalovirus infection. Arch Pediatr 2020; 27:160-165. [PMID: 32127242 DOI: 10.1016/j.arcped.2020.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the most common non-genetic cause of hearing loss and neurological disorder in children. Its overall prevalence is approximately 0.5% in Europe. In France, systematic screening during pregnancy is not recommended; screening is performed only if there are maternal or fetal symptoms suggestive of this infection. Approximately 90% of infected newborns are asymptomatic at birth, and among them the risk of neurosensory sequelae is 5-15%. By contrast, the prevalence of neurosensory impairment in symptomatic newborns at birth varies from 17% to 60%. Congenital CMV infection must be confirmed at birth before the 21st day of life by polymerase chain reaction (PCR) on saliva or urine samples. A complete clinical examination, blood tests (blood count, liver function test, CMV PCR), hearing tests, brain ultrasound and eye fundus examination should be performed. Neurological and auditory follow-up must be extended well beyond the neonatal period because the occurrence of neurosensory sequelae may be delayed. Oral valganciclovir is the recommended treatment in moderate or severe congenital CMV infections for a period of 6 weeks to 6 months; such treatment requires regular monitoring because of its possible side effects.
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Affiliation(s)
- M Nicloux
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - L Peterman
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - M Parodi
- Service d'ORL, CHU Necker-Enfants malades, 75015 Paris, France
| | - J-F Magny
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France.
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Melo A, Gama GL, Da Silva Júnior RA, De Assunção PL, Tavares JS, Da Silva MB, Costa KNFS, Vânia ML, Evangelista MA, De Amorim MMR. Motor function in children with congenital Zika syndrome. Dev Med Child Neurol 2020; 62:221-226. [PMID: 30945276 DOI: 10.1111/dmcn.14227] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 11/30/2022]
Abstract
AIM To evaluate gross motor function and associated factors in children with congenital Zika syndrome (CZS). METHOD Fifty-nine children (30 males, 29 females) with CZS at a mean (SD) age of 14.7 (3.9), months (range 5-29mo) were evaluated using the Gross Motor Function Measure (GMFM) and classified according to the Gross Motor Function Classification System (GMFCS). Neurological damage was evaluated by neuroimaging. The mothers' sociodemographic characteristics and general data on the children were obtained from interviews with the mothers and from the children's medical records. Correlational and multiple regression analyses were performed to identify factors associated with these children's motor function. RESULTS In 81% of the children, motor function impairment was severe, classified as GMFCS level V. The overall GMFM score ranged from 5 to 210 (median 18; interquartile range 11), with only four children receiving scores in the D and E dimensions. The factors found to affect motor function were the presence of severe malformations of cortical development and small head circumference at birth. INTERPRETATION Although motor impairment may be mild in some children, it is generally severe. Severe malformations of cortical development and small head circumference at birth were factors associated with poorer motor function, reflecting the greater severity of brain damage. WHAT THIS PAPER ADDS Motor impairment is severe in most children with congenital Zika syndrome (CZS). Motor skills are adequate or close to adequate for age in 7% of children with CZS. Severe malformations of cortical development are associated with poor motor control. Small head circumference at birth is also associated with poor motor control.
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Affiliation(s)
- Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Gabriela L Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Renan A Da Silva Júnior
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Paula L De Assunção
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Jousilene S Tavares
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Mariana B Da Silva
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Kamila N F S Costa
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Mell L Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Morgana A Evangelista
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
| | - Melania M R De Amorim
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil
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Melo RS, Lemos A, Paiva GS, Ithamar L, Lima MC, Eickmann SH, Ferraz KM, Belian RB. Vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with sensorineural hearing loss: A systematic review. Int J Pediatr Otorhinolaryngol 2019; 127:109650. [PMID: 31466025 DOI: 10.1016/j.ijporl.2019.109650] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies have demonstrated that children with sensorineural hearing loss (SNHL) exhibit postural instabilities, as well as balance and gait disorders, due to the vestibular dysfunction that they are prone to display as a consequence of inner ear injury. Thus, some experiments have proposed vestibular rehabilitation exercises programs as a treatment to improve these motor skills in children with SNHL. OBJECTIVE Assess the evidence quality of the trials that used vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL. METHODS This is a systematic review that surveyed articles in nine databases, published up to July 4, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants of both groups with clinical diagnosis of SNHL, aged up to 12 years old, with no physical problems, cognitive or neurological impairments, except the vestibular dysfunction. (3) Using vestibular rehabilitation exercises programs to improve the following outcomes: postural control, balance and/or gait. RESULTS Six experiments, including 153 children, met the inclusion criteria of this systematic review. Two randomized controlled trials (45 children) on the postural control exhibited low evidence quality and four others; three randomized and controlled trials (90 children) on the balance and one quasi-randomized (18 children) on the gait demonstrated very low evidence quality, respectively. CONCLUSION There is promising evidence that vestibular rehabilitation exercises programs improve the postural control, balance and gait of children with SNHL. However, due to the methodological limitations of the trials and low quality of current evidence on this topic, the trials results analyzed by this systematic review should be interpreted with caution. Due to the low quality of evidence observed in this review, we suggest that new trials be proposed on this topic, with better methodological quality, to prove the effectiveness of vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.
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Affiliation(s)
- Renato S Melo
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil.
| | - Andrea Lemos
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Giselle S Paiva
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Lucas Ithamar
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Marília C Lima
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Sophie Helena Eickmann
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Karla Mônica Ferraz
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Rosalie Barreto Belian
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Medicine, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Abstract
Congenital cytomegalovirus (cCMV) infection is the most common congenital infection worldwide and can lead to long-term impairments such as developmental delay. It is currently unknown how this affects the daily life of children and their parents. Children For this study, children with cCMV were identified by testing stored dried blood spots of 31,484 five-year-old children born in 2008 in the Netherlands. Parents of 133 children with cCMV and 274 children without cCMV participated and filled in questionnaires on the child's development, the child's and parents' quality of life, care provided for the children and consequences of cCMV on daily life. School performance reports at 6 years of age were also investigated. Children with cCMV had delays in general and expressive language development more often, and they attended physical therapists more frequently than children without cCMV. School performance of children with cCMV and symptoms at birth was poorer than that of cCMV-negative children with similar symptoms at birth. The quality of life of children with long-term impairment was lower in children with cCMV than those without cCMV. Parents of children with cCMV and long-term impairments reported more physical and concentration problems than parents of children without cCMV. These findings indicate that cCMV has a considerable impact not only on the child's development and school performance but also on the daily life of children and their parents. The care for children with cCMV should therefore include support for motor and speech-language development as well as family-centered care.
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12
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Muldoon KM, Armstrong-Heimsoth A, Thomas J. Knowledge of congenital cytomegalovirus (cCMV) among physical and occupational therapists in the United States. PLoS One 2017; 12:e0185635. [PMID: 28976995 PMCID: PMC5627927 DOI: 10.1371/journal.pone.0185635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/15/2017] [Indexed: 12/03/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) infections cause more children to have permanent disabilities than Down Syndrome, Fetal Alcohol Syndrome, Spina Bifida, and pediatric HIV/AIDS combined. The risk of infection during pregnancy can be significantly decreased using universal precautions, such as thorough handwashing and cleansing of surfaces and objects that have come into contact with infected body fluids. Children under 3 years of age are commonly asymptomatic excretors of CMV, with the highest viral loads present in saliva. Pediatric therapists have regular close contact with young children, and are thus likely at elevated occupational risk of acquiring CMV. Our objective was to evaluate therapist knowledge of cCMV and its transmission. We recruited American Occupational Therapy Association (AOTA) and American Physical Therapy Association (APTA) members via electronic newsletters and printed flyers from April to September 2015. Participants completed an online, anonymous 24-question survey using Survey Monkey. We compared responses between groups and previously published CMV awareness data using binomial tests of difference of proportions and multiple logistic regression. Our study identified both a low level of therapist awareness and poor demonstrated understanding of cCMV. Self-reported cCMV awareness amongst therapists was greater than awareness in the general population, and equivalent to awareness amongst health care professionals. Whereas 52% of participants self-reported awareness of cCMV, only 18% demonstrated understanding of the behavioral modes of CMV transmission. Fewer therapists reported awareness of cCMV than other, less prevalent conditions. Higher levels of health risk knowledge were associated with greater contact with children. Most participants reported learning about cCMV from the workplace. The knowledge gaps between self-reported awareness of cCMV and demonstrated understanding of modes of transmission described by our results emphasize the need for additional training of therapists. cCMV is preventable, and accurate knowledge of modes of transmission is crucial for the health of practitioners and clients.
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Affiliation(s)
- Kathleen M. Muldoon
- Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, United States of America
- * E-mail:
| | - Amy Armstrong-Heimsoth
- Department of Occupational Therapy, Northern Arizona University, Phoenix, Arizona, United States of America
| | - Jodi Thomas
- Department of Physical Therapy, Midwestern University, Glendale, Arizona, United States of America
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13
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Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: A systematic review. Rev Med Virol 2017; 27:e1938. [PMID: 28876493 DOI: 10.1002/rmv.1938] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Congenital CMV is one of the commonest congenital infections and a recognised cause of sensorineural hearing loss and neurodevelopmental impairment. Ninety percent are clinically inapparent at birth but are reported to be at risk of developing such abnormalities throughout childhood, the extent of which requires further elucidation. METHODS A systematic literature review was conducted using Medline and Embase databases, manual citation review, and personal libraries for articles reporting primary data on hearing and neurodevelopmental outcomes for children with asymptomatic congenital CMV. PROSPERO registration number CRD42015025407. RESULTS Thirty-seven of 480 articles identified between 1969 and 2016 met the eligibility criteria. Twenty-nine of these contributed primary data on hearing outcomes and 20 on neurodevelopmental outcomes (12 of the 37 studies contributed data on both). Cumulative incidence of sensorineural hearing loss with follow-up to at least 5 years was 7% to 11%, which is more than healthy controls but less than children with symptomatic congenital CMV (34%-41%). The onset, course, and severity of hearing loss was variable with no reliable virological prognostic marker. In comparison to controls, children with asymptomatic congenital CMV did not perform worse than controls in neurodevelopmental assessments and performed better than children with symptomatic congenital CMV. CONCLUSIONS Studies show children with asymptomatic congenital CMV are at increased risk of developing hearing loss but perform equally well on neurodevelopmental assessments when compared with healthy controls. There is no reliable virological marker to determine which infants will develop sequelae. Regular follow-up until school entry is supported by the literature.
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Affiliation(s)
- Adam W Bartlett
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Brendan McMullan
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - William D Rawlinson
- Serology and Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
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14
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Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: A systematic review. Rev Med Virol 2017. [DOI: 10.1002/rmv.1938 10.1002/rmv.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adam W. Bartlett
- School of Women's and Children's Health; UNSW Sydney; Sydney Australia
- Biostatistics and Databases Program; The Kirby Institute, UNSW Sydney; Sydney Australia
| | - Brendan McMullan
- School of Women's and Children's Health; UNSW Sydney; Sydney Australia
- Department of Immunology and Infectious Diseases; Sydney Children's Hospital; Randwick New South Wales Australia
| | - William D. Rawlinson
- Serology and Virology Division; SEALS Microbiology, Prince of Wales Hospital; Sydney Australia
- School of Medical Sciences; University of New South Wales; Sydney New South Wales Australia
- School of Biotechnology and Biomolecular Sciences; University of New South Wales; Sydney New South Wales Australia
| | - Pamela Palasanthiran
- School of Women's and Children's Health; UNSW Sydney; Sydney Australia
- Department of Immunology and Infectious Diseases; Sydney Children's Hospital; Randwick New South Wales Australia
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15
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Valnoctamide Inhibits Cytomegalovirus Infection in Developing Brain and Attenuates Neurobehavioral Dysfunctions and Brain Abnormalities. J Neurosci 2017. [PMID: 28630251 DOI: 10.1523/jneurosci.0970-17.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common infectious cause of brain defects and neurological dysfunction in developing human babies. Due to the teratogenicity and toxicity of available CMV antiviral agents, treatment options during early development are markedly limited. Valnoctamide (VCD), a neuroactive mood stabilizer with no known teratogenic activity, was recently demonstrated to have anti-CMV potential. However, it is not known whether this can be translated into an efficacious therapeutic effect to improve CMV-induced adverse neurological outcomes. Using multiple models of CMV infection in the developing mouse brain, we show that subcutaneous low-dose VCD suppresses CMV by reducing the level of virus available for entry into the brain and by acting directly within the brain to block virus replication and dispersal. VCD during the first 3 weeks of life restored timely acquisition of neurological milestones in neonatal male and female mice and rescued long-term motor and behavioral outcomes in juvenile male mice. CMV-mediated brain defects, including decreased brain size, cerebellar hypoplasia, and neuronal loss, were substantially attenuated by VCD. No adverse side effects on neurodevelopment of uninfected control mice receiving VCD were detected. Treatment of CMV-infected human fetal astrocytes with VCD reduced both viral infectivity and replication by blocking viral particle attachment to the cell, a mechanism that differs from available anti-CMV drugs. These data suggest that VCD during critical periods of neurodevelopment can effectively suppress CMV replication in the brain and safely improve both immediate and long-term neurological outcomes.SIGNIFICANCE STATEMENT Cytomegalovirus (CMV) can irreversibly damage the developing brain. No anti-CMV drugs are available for use during fetal development, and treatment during the neonatal period has substantial limitations. We studied the anti-CMV actions of valnoctamide (VCD), a psychiatric sedative that appears to lack teratogenicity and toxicity, in the newborn mouse brain, a developmental period that parallels that of an early second-trimester human fetus. In infected mice, subcutaneous VCD reaches the brain and suppresses viral replication within the CNS, rescuing the animals from CMV-induced brain defects and neurological problems. Treatment of uninfected control animals exerts no detectable adverse effects. VCD also blocks CMV replication in human fetal brain cells.
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