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. 2021 Mar 1;72(5):e146-e153.
doi: 10.1093/cid/ciaa1833.

Neurodevelopmental Outcomes of Children Following In Utero Exposure to Zika in Nicaragua

Elizabeth M Stringer  1 , Evelin Martinez  2 , Bryan Blette  3 , Christian Eduardo Toval Ruiz  2 , Michael Boivin  4 , Omar Zepeda  2 , Jeffrey S A Stringer  1 , Marlen Morales  2 , Shiara Ortiz-Pujols  5 , Itziar Familiar  4 , Matthew Collins  6 , Meylin Chavarria  2 , Barbara Goldman  7 , Natalie Bowman  8 , Aravinda de Silva  9 , Daniel Westreich  10 , Michael Hudgens  3 , Sylvia Becker-Dreps  11 , Filemon Bucardo  2
Affiliations

Neurodevelopmental Outcomes of Children Following In Utero Exposure to Zika in Nicaragua

Elizabeth M Stringer et al. Clin Infect Dis. .

Abstract

Background: Neurodevelopmental outcomes of asymptomatic children exposed to Zika virus (ZIKV) in utero are not well characterized.

Methods: We prospectively followed 129 newborns without evidence of congenital Zika syndrome (CZS) up to 24 months of age. Participants were classified as ZIKV exposed or ZIKV unexposed. The Mullen Scales of Early Learning (MSEL) was administered in the participants' homes at 6, 12, 15, 18, 21, and 24 months of age by trained psychologists. Sociodemographic data, medical history, and infant anthropometry at birth were collected at each home visit. Our primary outcome was the Mullen Early Learning Composite Score (ECL) at 24 months of age between our 2 exposure groups. Secondary outcomes were differences in MSEL subscales over time and at 24 months.

Results: Of 129 infants in whom exposure status could be ascertained, 32 (24.8%) met criteria for in utero ZIKV exposure and 97 (75.2%) did not. There were no differences in maternal age, maternal educational attainment, birthweight, or gestational age at birth between the 2 exposure groups. The adjusted means and standard errors (SEs) for the ELC score between the ZIKV-exposed children compared to ZIKV-unexposed children were 91.4 (SE, 3.1) vs 96.8 (SE, 2.4) at 12 months and 93.3 (SE, 2.9) vs 95.9 (SE, 2.3) at 24 months. In a longitudinal mixed model, infants born to mothers with an incident ZIKV infection (P = .01) and low-birthweight infants (<2500 g) (P = .006) had lower composite ECL scores.

Conclusions: In this prospective cohort of children without CZS, children with in utero ZIKV exposure had lower neurocognitive scores at 24 months.

Keywords: Nicaragua; Zika; children; neurodevelopmental outcome.

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Figures

Figure 1.
Figure 1.
Study profile. *8 infants had 2 MSEL around 3-9 months yielding 137 assessments for 129 infants in the 6-month range. Abbreviations: MSEL, Mullen Scales of Early Learning; ZIKV, Zika virus.
Figure 2.
Figure 2.
Adjusted longitudinal mixed model: Zika virus exposure status. Abbreviations: MSEL, Mullen Scales of Early Learning; ZIKV, Zika virus.
Figure 3.
Figure 3.
Adjusted longitudinal mixed model: Zika virus exposure status. Abbreviations: MSEL ELC, Mullen Scales of Early Learning Early Learning Composite; ZIKV, Zika virus.
See this image and copyright information in PMC

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