Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017

Abstract

Background: Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life.

Objective: To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood.

Methods: The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes.

Results: Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation.

Conclusion: Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.

Keywords: Zika virus; child development; eye; hearing; neurologic examination.

FIGURE 1

Escala Abreviada de Desarrollo, version 1^a (EAD-1) percentiles^b at 20 to 30 mo of age by domain and age at Zika symptom onset of children postnatally infected with ZIKV^c and without adverse neurologic, eye, or hearing outcomes (N = 51^d), Colombia, September-November 2017^e. ^aThe EAD-1 is a standardised, validated developmental screening tool in Colombia. ^bEAD-1 scores from the sample were converted into percentiles based on the normed Colombian population. ^c Participants were laboratory-confirmed with ZIKV infection by serum rRT-PCR within one week of symptom onset at 1–12 mo of age. ^dFour children in the hearing-language domain and one child in the personal-social domain, whose respective domain scores could not be calculated due to incorrect EAD-1 application, were excluded. ^eThe four lowest percentiles in the personal-social domain are driving the correlation; if these four points were removed, the correlation is no longer statistically significant