Outcomes up to age 36 months after congenital Zika virus infection-U.S. states

Abstract

Background: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure.

Methods: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively.

Results: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay.

Conclusion: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families.

Impact: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Fig. 1. Frequency of neurologic sequelae by presence of ZBD.

Children with developmental follow-up data and reported neurologic sequelae^a, with and without Zika-associated birth defects^b (ZBD) (n = 76/1881 [50/112 children with ZBD and 26/1769 children without ZBD]), U.S. Zika Pregnancy and Infant Registry, U.S. States and DC. ^aY-axis shows percentage of children presenting with each abnormality among those with any neurologic sequelae. ^bThe case definition for ZBD has been previously described.^,

Fig. 2. Age at assessment (in months) of neurodevelopment by presence of ZBD.

Children with developmental follow-up data by age interval at assessment^a, with and without Zika-associated birth defects^b (ZBD) (N = 1848), U.S. Zika Pregnancy and Infant Registry, U.S. States and DC. ^aDenominator for each domain is all children with any notation of developmental data for each time point. ^bThe case definition for ZBDs has been previously described.^,

Fig. 3. Children with confirmed or possible developmental delay across developmental domains by presence of ZBD.

Children with developmental follow-up data who are classified as having confirmed^a or possible^b developmental delay by domain, with and without Zika-associated birth defects^c (ZBD) (N = 1848), U.S. Zika Pregnancy and Infant Registry, U.S. States and DC. ^aConfirmed developmental delay: submitted specialist assessment, receipt of therapy, or multiple notations of delay with supportive neuroimaging findings. ^bPossible developmental delay: failing ≥1 domain on a validated screener at ≥1 time point, or ≥2 domains noted as abnormal at ≥2 time points but not reported as a validated screener. ^cThe case definition for ZBD has been previously described.^,