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. 2020 Jun 10;70(12):2663-2672.
doi: 10.1093/cid/ciz704.

Early Clinical Infancy Outcomes for Microcephaly and/or Small for Gestational Age Zika-Exposed Infants

Kristina Adachi  1 , Tahmineh Romero  2 , Karin Nielsen-Saines  1 , Sheila Pone  3 , Mitsue Aibe  3 , Elisa Barroso de Aguiar  3 , Myung Sim  2 , Patricia Brasil  4 , Andrea Zin  3 , Irena Tsui  5 , Stephanie L Gaw  6 , Umme-Aiman Halai  7 , Zilton Vasconcelos  3 , Jose Paulo Pereira  3 , Tania Saad Salles  3 , Claudia Neves Barbosa  3 , Elyzabeth Portari  3 , James D Cherry  1 , Marcos Pone  3 , Maria Elisabeth Moreira  2
Affiliations

Early Clinical Infancy Outcomes for Microcephaly and/or Small for Gestational Age Zika-Exposed Infants

Kristina Adachi et al. Clin Infect Dis. .

Abstract

Background: Zika-exposed infants with microcephaly (proportional or disproportional) and those who are small for gestational age without microcephaly should be closely followed, particularly their growth trajectories. They are at high risk of adverse outcomes in the first year of life.Antenatal Zika virus (ZIKV) exposure may lead to adverse infant outcomes including microcephaly and being small for gestational age (SGA). ZIKV-exposed infants with a diagnosis of microcephaly (proportional [PM] or disproportional [DM]) or SGA at birth were evaluated with anthropometric measurements and health outcomes.

Methods: Infants had laboratory-confirmed ZIKV exposure in Brazil. PM, DM, or SGA classification was based on head circumference and weight. First-year growth parameters and clinical outcomes were recorded with analyses performed.

Results: Among the 156 ZIKV-exposed infants, 14 (9.0%) were SGA, 13 (8.3%) PM, 13 (8.3%) DM, and 116 (74.4%) were neither SGA nor had microcephaly (NSNM). High rates of any neurologic, ophthalmologic, and hearing abnormalities were observed for PM (100%), DM (100%), and SGA (42.9%) vs NSNM infants (18.3%; P <.001); odds ratio [OR], 3.4 (95% confidence interval [CI], 1.1-10.7) for SGA vs NSNM. Neuroimaging abnormalities were seen in 100% of PM and DM and in 42.9% of SGA vs NSNM infants 16%; (P <.001); OR 3.9 (95% CI, 1.2-12.8) for SGA vs NSNM. Growth rates by z score, particularly for microcephaly infants, were poor after birth but showed improvement beyond 4 months of life.

Conclusions: ZIKV-exposed infants with microcephaly (PM and DM) had similarly high rates of adverse outcomes but showed improvement in growth measurements beyond 4 months of life. While SGA infants had fewer adverse outcomes compared with microcephaly infants, notable adverse outcomes were observed in some; their odds of having adverse outcomes were 3 to 4 times greater compared to NSNM infants.Zika-exposed infants with microcephaly, irrespective of being proportional or disproportional, and those who are small for gestational age without microcephaly should be closely followed, particularly their growth trajectories. They are at high risk of adverse outcomes in the first year of life.

Keywords: Zika; congenital Zika syndrome; microcephaly; proportional microcephaly; small for gestational age (SGA).

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Figures

Figure 1.
Figure 1.
Piecewise regression lines for head circumference, weight, and length z scores over 12 months for proportional microcephaly, disproportional microcephaly, and Zika virus–infected infants, knot at 4 months. The figure shows mean z scores and piecewise regression (prediction) lines of mean z scores for head circumference, weight, and length during the first year of life for each of the 3 ZIKV-exposed infant groups (PM, DM, SGA). Abbreviations: DM, disproportional; PM, proportional; SGA, small for gestational age.
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References

    1. Moore CA, Staples JE, Dobyns WB, et al. . Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr 2017;171:288–95. doi:10.1001/jamapediatrics.2016.3982. - PMC - PubMed
    1. PAHO WHO. Regional Zika epidemiological update (Americas) 2016.
    1. PAHO WHO. Zika suspected and confirmed cases reported by countries and territories in the Americas Cumulative cases, 2015–2016 Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=....
    1. PAHO WHO. Zika cases and congenital syndrome associated with Zika virus reported by countries and territories in the Americas, 2015–12017: cumulative cases 2017.
    1. Lanciotti RS, Kosoy OL, Laven JJ, et al. . Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008; 14:1232–9. - PMC - PubMed

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