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Mattos AM, Rastely-Junior VN, Pires MM, Aguilar JP, Lessa MSA, Regis C, Wanderley M, Leony J, Bouzon J, Ballalai V, Vieira C, Carvalho GBS, Almeida JRM, Nery N, Leal R, Costa F, Ko AI, Reis MG, Oliveira-Filho J. Predictors of Neurodevelopment in Microcephaly Associated with Congenital Zika Syndrome: A Prospective Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1831. [PMID: 38136033 PMCID: PMC10741834 DOI: 10.3390/children10121831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
The municipality of Salvador, situated in Brazil, distinguished itself as the epicenter of the emergence of microcephaly related to congenital manifestations of Zika syndrome. Despite the anticipated significant developmental setbacks in these children, research has indicated a varied range of outcomes, with certain instances even reflecting minimal developmental delay. Our objective was to pinpoint determinants that could forecast developmental anomalies in children diagnosed with microcephaly associated with congenital Zika syndrome (CZS). METHODOLOGY A forward-looking clinical and neurodevelopmental examination was conducted focusing on neonates diagnosed with microcephaly with CZS, birthed between September 2015 and April 2016 at the Hospital Geral Roberto Santos, in Salvador city. That infants were monitored up to their third year by a multiprofessional team. Child development was assessed using the composite Bayley III score. Undertaken by two blinded experts, cranial CT scan analysis was performed during the neonate period for the detection of brain abnormalities and to quantify ventricle enlargement, measured by Evans' index (EI). RESULTS Fifty newborns were evaluated with a median head circumference of 28 cm (interquartile range 27-31 cm). EI was associated with neurodevelopmental delay at three years and remained significant after adjustment for head circumference. A 0.1-point increase in EI was associated with a delay of 3.2 months in the receptive language (p = 0.016), 3.4 months in the expressive language (p = 0.016), 3.4 months in the cognitive (p = 0.016), 2.37 months in the gross motor (p = 0.026), and 3.1 months in the fine motor (p = 0.021) domains. CONCLUSIONS EI predicted neurodevelopmental delay in all Bayley domains in children with microcephaly associated with CZS.
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Affiliation(s)
- Adriana M. Mattos
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil; (M.M.P.); (J.B.); (R.L.); (J.O.-F.)
| | - Valmir N. Rastely-Junior
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Matheus M. Pires
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil; (M.M.P.); (J.B.); (R.L.); (J.O.-F.)
| | - Juan P. Aguilar
- Post-Graduate Program in Public Health, Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40170-110, Brazil; (J.P.A.); (M.S.A.L.); (N.N.J.); (F.C.)
| | - Millani S. A. Lessa
- Post-Graduate Program in Public Health, Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40170-110, Brazil; (J.P.A.); (M.S.A.L.); (N.N.J.); (F.C.)
| | - Clarina Regis
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Mariana Wanderley
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Julio Leony
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Joseane Bouzon
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil; (M.M.P.); (J.B.); (R.L.); (J.O.-F.)
| | - Verena Ballalai
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Carina Vieira
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - Gustavo B. S. Carvalho
- Hospital Geral Roberto Santos, Salvador 40301-110, Brazil; (V.N.R.-J.); (C.R.); (M.W.); (J.L.); (V.B.); (C.V.); (G.B.S.C.)
| | - João R. M. Almeida
- Hospital Professor Edgard Santos, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - Nivison Nery
- Post-Graduate Program in Public Health, Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40170-110, Brazil; (J.P.A.); (M.S.A.L.); (N.N.J.); (F.C.)
- Gonçalo Moniz Institute, Foundation Oswaldo Cruz, Salvador 40296-710, Brazil;
| | - Rodrigo Leal
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil; (M.M.P.); (J.B.); (R.L.); (J.O.-F.)
| | - Federico Costa
- Post-Graduate Program in Public Health, Institute of Collective Health (ISC), Federal University of Bahia, Salvador 40170-110, Brazil; (J.P.A.); (M.S.A.L.); (N.N.J.); (F.C.)
- Gonçalo Moniz Institute, Foundation Oswaldo Cruz, Salvador 40296-710, Brazil;
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Mitermayer G. Reis
- Gonçalo Moniz Institute, Foundation Oswaldo Cruz, Salvador 40296-710, Brazil;
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Jamary Oliveira-Filho
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador 40170-110, Brazil; (M.M.P.); (J.B.); (R.L.); (J.O.-F.)
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Ribeiro CTM, Hamanaka T, Pone S, Aibe MS, Gomes SC, Nielsen-Saines K, Brickley EB, Moreira ME, Pone M. Gross motor function in children with Congenital Zika Syndrome from Rio de Janeiro, Brazil. Eur J Pediatr 2022; 181:783-788. [PMID: 34596742 PMCID: PMC8821062 DOI: 10.1007/s00431-021-04270-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Carla Trevisan M Ribeiro
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil.
| | - Tatiana Hamanaka
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
| | - Sheila Pone
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
| | - Mitsue Senra Aibe
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
| | - Saint Clair Gomes
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
| | | | | | - Maria Elisabeth Moreira
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
| | - Marcos Pone
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, 22250-020, Brazil
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Morris SK, Farrar DS, Miller SP, Ofner M, Bitnun A, Nelson CRM, Shevell M, Moore AM, Tataryn J, Evans JA, Zipursky AR, Moore Hepburn C. Population-based surveillance of severe microcephaly and congenital Zika syndrome in Canada. Arch Dis Child 2021; 106:855-861. [PMID: 33419730 DOI: 10.1136/archdischild-2020-320968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To estimate the minimum incidence of congenital Zika syndrome (CZS) and severe microcephaly in Canada and describe key clinical, epidemiological, aetiological and outcome features of these conditions. METHODS Two separate national surveillance studies were conducted on CZS and severe microcephaly using the well-established Canadian Paediatric Surveillance Program from 2016 to 2019. Over 2700 paediatricians across Canada were surveyed monthly and asked to report demographic details, pregnancy and travel history, infant anthropometry, clinical features and laboratory findings of newly identified cases. Reports were reviewed to assign an underlying aetiology of severe microcephaly. Incidence rates were estimated using monthly live birth denominators. RESULTS Thirty-four infants met the case definition for severe microcephaly and <5 met the case definition for CZS. The associated minimum incidence rates were 4.5 per 100 000 live births for severe microcephaly and 0.1-0.5 per 100 000 live births for CZS. Of severe microcephaly cases, 53% were attributed to genetic causes, 15% to infectious or ischaemic causes and 32% to unknown causes. The median head circumference-for-age Z-score at birth was -3.2 (IQR -3.8 to -2.6), and catch-up growth was often not achieved. Common clinical features included intracranial abnormalities (n=23), dysmorphology (n=19) and developmental delays (n=14). Mothers of infants with non-genetic aetiologies travelled during pregnancy more often (10/16) than mothers of infants with genetic aetiologies (<5/18; p<0.01). CONCLUSION Severe microcephaly and CZS are both rare in Canada. Minimum incidence rates can be used as a baseline against which novel or re-emergent causes of severe microcephaly or CZS can be compared.
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Affiliation(s)
- Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada .,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel S Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven P Miller
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marianna Ofner
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Chantal R M Nelson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Aideen M Moore
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Tataryn
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jane A Evans
- Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy R Zipursky
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charlotte Moore Hepburn
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Berberian G, Bologna R, Pérez MG, Mangano A, Costa M, Calligaris S, Morales MA, Rugilo C, Ruiz-Burga E, Thorne C. Causes of Microcephaly in the Zika Era in Argentina: A Retrospective Study. Glob Pediatr Health 2021; 8:2333794X211040968. [PMID: 34435083 PMCID: PMC8381406 DOI: 10.1177/2333794x211040968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
There are gaps in understanding the causes and consequences of microcephaly. This paper describes the epidemiological characteristics, clinical presentations, and etiologies of children presenting microcephaly during the Zika outbreak in Argentina. This observational retrospective study conducted in the pediatric hospital of Juan P. Garrahan reviewed the medical records of 40 children presenting microcephaly between March 2017 and November 2019. The majority (60%) were males and born full-term. At first evaluation, microcephaly was defined as congenital (31/40, 77%) and associated with other features (68%) such as seizures, developmental delay, non-progressive chronic encephalopathy, and West Syndrome. It was found manifestations restricted to central nervous system (55%), ocular (8/40, 20%), and acoustic (9/40, 23%) defects, and abnormal neuroimaging findings (31/39, 79%). Non-infectious diseases were the primary cause of isolated microcephaly (21/37, 57%), largely related to genetic diseases (13/21, 62%). Only 3 were children were diagnosed with Congenital Zika infection (3/16, 7.5%).
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Affiliation(s)
| | - Rosa Bologna
- Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina
| | | | - Andrea Mangano
- Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina
| | - Marina Costa
- Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina
| | | | - María Alejandra Morales
- Instituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui, Buenos Aires Province, Argentina
| | - Carlos Rugilo
- Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina
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Prevalence of congenital microcephaly and its risk factors in an area at risk of Zika outbreaks. BMC Pregnancy Childbirth 2021; 21:214. [PMID: 33731027 PMCID: PMC7972338 DOI: 10.1186/s12884-021-03705-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Prevalence of neonatal microcephaly in populations without Zika-epidemics is sparse. The study aimed to report baseline prevalence of congenital microcephaly and its relationship with prenatal factors in an area at risk of Zika outbreak. Methods This study included singletons born after 24 gestational weeks in 2017–2018 at four hospitals in Guangzhou, China. Microcephaly was defined as a head circumference at birth >3SD below the mean for sex and gestational age. Prevalence of microcephaly was estimated by binomial exact method. Multivariable logistic regression was used to examine the associations of microcephaly with prenatal factors. The population attributable fraction (PAF) for associated risk factors was calculated. Results Of 46,610 live births included, 154 (3.3, 95% CI 2.8–3.9 per 1000 live births) microcephalies were identified. Maternal hepatitis B virus carriers (HBV, OR 1.80, 95% CI 1.05–3.10) and primipara (OR 2.68, 95% CI 1.89–3.81) had higher risk of having a microcephalic baby. Higher prevalence of microcephaly was observed in women who had premature labor (OR 1.98, 95% CI 1.17–3.34) and had a baby with fetal growth restriction (OR 16.38, 95% CI 11.81–22.71). Four identified factors (HBV, primiparity, preterm labor, and fetal growth restriction) contributed to 66.4% of the risk of microcephaly. Conclusions The prevalence of microcephaly in Guangzhou was higher than expected. This study identified four prenatal risk factors that, together, contributed to two-thirds of the increased risk of microcephaly. This is the first reported association between maternal HBV carrier status and microcephaly.
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White M, Connor KL. In Utero HIV Exposure and the Early Nutritional Environment Influence Infant Neurodevelopment: Findings from an Evidenced Review and Meta-Analysis. Nutrients 2020; 12:nu12113375. [PMID: 33147767 PMCID: PMC7692402 DOI: 10.3390/nu12113375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
The developing brain is especially vulnerable to infection and suboptimal nutrition during the pre- and early postnatal periods. Exposure to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapies (ART) in utero and during breastfeeding can adversely influence infant (neuro) developmental trajectories. How early life nutrition may be optimised to improve neurodevelopmental outcomes for infants who are HIV-exposed has not been well characterised. We conducted an up-to-date evidence review and meta-analysis on the influence of HIV exposure in utero and during breastfeeding, and early life nutrition, on infant neurodevelopmental outcomes before age three. We report that exposure to maternal HIV infection may adversely influence expressive language development, in particular, and these effects may be detectable within the first three years of life. Further, while male infants may be especially vulnerable to HIV exposure, few studies overall reported sex-comparisons, and whether there are sex-dependent effects of HIV exposure on neurodevelopment remains a critical knowledge gap to fill. Lastly, early life nutrition interventions, including daily maternal multivitamin supplementation during the perinatal period, may improve neurodevelopmental outcomes for infants who are HIV-exposed. Our findings suggest that the early nutritional environment may be leveraged to improve early neurodevelopmental trajectories in infants who have been exposed to HIV in utero. A clear understanding of how this environment should be optimised is key for developing targeted nutrition interventions during critical developmental periods in order to mitigate adverse outcomes later in life and should be a priority of future research.
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Miranda RN, Ximenes R, Gebretekle GB, Bielecki JM, Sander B. Health-Related Quality of Life in Neurological Disorders Most Commonly Associated With Zika-Virus Infection: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:969-976. [PMID: 32762999 DOI: 10.1016/j.jval.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/31/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In this systematic review, we synthesize the current evidence on health-related quality of life (HRQoL) for the two of the most relevant outcomes of Zika virus infection in humans, microcephaly and Guillain-Barré Syndrome (GBS). METHODS We searched the following databases: MEDLINE, Embase, CINAHL, LILACS, WHO's ICTRP clinical trials registries database and PROSPERO. Search terms included quality of life, microcephaly, and Guillain-Barré Syndrome. We included primary studies where HRQoL was quantitatively assessed for microcephaly and GBS using validated instruments. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the risk of bias of individual studies. RESULTS From a total of 1,657 abstracts screened and 66 full texts reviewed, 21 studies met the eligibility criteria; one study for microcephaly and 20 for GBS. Adjusted disutilities for microcephaly compared to a normative childhood utility ranged from -0.745 to -0.820. For GBS, time traded-off the expected lifetime ranged from 16 days to 3 years. HRQoL follows the clinical course of GBS, with lower scores in the first months, recovery within the first year post onset, and stabilization after one year. CONCLUSIONS Included studies reported a wide range of HRQoL for GBS, due in part to a high level of heterogeneity in methods, inclusion criteria, follow-up and reporting of results. Opportunities exist for primary studies assessing the longitudinal HRQoL over the entire course of the diseases to inform clinical practice, economic evaluations and health policy.
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Affiliation(s)
- Rafael N Miranda
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada.
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Gebremedhin B Gebretekle
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; School of Pharmacy, Addis Ababa University, Ethiopia
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Beate Sander
- University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
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Alves LV, Mello MJG, Bezerra PG, Alves JGB. Congenital Zika Syndrome and Infantile Spasms: Case Series Study. J Child Neurol 2018; 33:664-666. [PMID: 29897010 DOI: 10.1177/0883073818780105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently described, the congenital Zika syndrome caused by the Zika virus has many features of other congenital infections. This case series study reports 22 infants with congenital Zika syndrome in Brazil who developed infantile spasms during their first year of life. The median age of infantile spasms onset was 4.3 (±1.4) months and ranged from 1 to 7 months. Neurologic evaluation showed that all 22 children presented severe impairment of neuropsychomotor development. A total of 18 infants had an interictal hypsarrhythmia electroencephalogram (EEG) pattern. Vigabatrin was prescribed as first-line treatment; however, only 5 patients were controlled. Steroid regimes were started for children who did not respond to vigabatrin and they are being followed. In conclusion, congenital Zika syndrome may be considered as an etiological agent of infantile spasms.
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Affiliation(s)
- Lucas V Alves
- 1 Department of Paediatrics Neurology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Boa Vista, Recife, Brazil
| | - Maria J G Mello
- 1 Department of Paediatrics Neurology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Boa Vista, Recife, Brazil
| | - Patrícia G Bezerra
- 1 Department of Paediatrics Neurology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Boa Vista, Recife, Brazil
| | - João Guilherme Bezerra Alves
- 1 Department of Paediatrics Neurology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Boa Vista, Recife, Brazil
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9
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Alves LV, Paredes CE, Silva GC, Mello JG, Alves JG. Neurodevelopment of 24 children born in Brazil with congenital Zika syndrome in 2015: a case series study. BMJ Open 2018; 8:e021304. [PMID: 30012787 PMCID: PMC6082469 DOI: 10.1136/bmjopen-2017-021304] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the neurodevelopment of children with congenital Zika syndrome during the second year of life. DESIGN Case series study. SETTING Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Pernambuco, Brazil. PARTICIPANTS 24 children with congenital Zika syndrome born with microcephaly during the Zika outbreak in Brazil in 2015 and followed up at the IMIP during their second year of life. MAIN OUTCOME MEASURE Denver Developmental Screening Test II, head circumference and clinical neurological examination. RESULTS All children presented neurodevelopmental delay: for an average chronological age of 19.9 months, language was equivalent to that of age 2.1 months, gross motor 2.7 months, fine motor/adaptive 3.1 months and personal/social 3.4 months. Head circumference remained below the third percentile for age and gender, and growth rate up to the second year of life was 10.3 cm (expected growth 13 cm). Muscle tone was increased in 23 (95.5%) of 24 children, musculotendinous reflexes were increased in the whole sample and clonus was present in 18 (77.3%) of 24 children. All children except one had epilepsy. CONCLUSION Children born with microcephaly associated with congenital Zika virus have a significant neurodevelopmental delay.
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Affiliation(s)
- Lucas V Alves
- Department of Paediatrics Neurology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Camila E Paredes
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Germanna C Silva
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Júlia G Mello
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - João G Alves
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
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