Practice parameter: evaluation of the child with microcephaly (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society

Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015

OBJECTIVE

To assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil.

METHODS

We contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than -3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2.

FINDINGS

Between 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2-8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012.

CONCLUSION

The numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.

Zika Virus: Practical Information for the Plastic and Reconstructive Surgeon

The ongoing Zika virus outbreak in South, Central, and, most recently, North America has become a global health care emergency. Originally thought to be a benign, self-limiting viral syndrome, the newest epidemic has provided convincing evidence that maternal Zika virus infection can lead to neonatal malformations, the so-called congenital Zika syndrome. The alarming number of microcephalic neonates being born during the current outbreak is most notable, though several other anomalies, such as arthrogryposis, redundant scalp tissue, and cranial collapse, have been reported. Additionally, Zika virus represents an occupational hazard to plastic and reconstructive surgeons and their teams, as well as an infectious risk to patients receiving blood and human tissue products. In this article, we aim to provide current disease-related information to help guide the practicing plastic surgeon in the safe and effective management of patients affected by congenital Zika syndrome and to educate plastic surgeons regarding occupational and transmissivity risks of Zika virus.