Perinatal characteristics and longer-term outcomes in Brazilian children with confirmed or suspected congenital Zika infection: ZIKAction Paediatric Registry

Isadora Cristina de Siqueira; Breno Lima de Almeida; Maria Lucia Costa Lage; Leticia Serra; Alessandra Carvalho; Maricélia Maia de Lima; Maria de Fatima Neri Góes; Marília De Santa Inês Neri Crispim; Mirela Monteiro da Costa Pereira; Bernardo Gratival Gouvea Costa; Heather Bailey; Thomas Byrne; Carlo Giaquinto; Georgina Fernandes; Elisa Ruiz-Burga; Claire Thorne

doi:10.1016/j.dialog.2023.100104

Perinatal characteristics and longer-term outcomes in Brazilian children with confirmed or suspected congenital Zika infection: ZIKAction Paediatric Registry

Dialogues Health. 2023 Jan 20:2:100104. doi: 10.1016/j.dialog.2023.100104. eCollection 2023 Dec.

Authors

Isadora Cristina de Siqueira¹, Breno Lima de Almeida¹, Maria Lucia Costa Lage¹, Leticia Serra², Alessandra Carvalho³, Maricélia Maia de Lima⁴, Maria de Fatima Neri Góes⁵, Marília De Santa Inês Neri Crispim⁵, Mirela Monteiro da Costa Pereira¹, Bernardo Gratival Gouvea Costa¹, Heather Bailey⁶, Thomas Byrne⁷, Carlo Giaquinto⁸, Georgina Fernandes⁷, Elisa Ruiz-Burga^{6

7}, Claire Thorne⁷

Affiliations

¹ Instituto Gonçalo Moniz-Fiocruz, Rua Waldemar Falcão, 121, Candeal, Salvador, BA, Brazil.
² Centro de Prevenção e Reabilitação da Pessoa com Deficiência - Cepred, Av. Antônio Carlos Magalhães, S/N, Parque Bela Vista, 40279-700 Salvador, BA, Brazil.
³ Rede SARAH de Hospitais de Reabilitação, Av. Tancredo Neves, 2782 - Caminho das Árvores, 41820-900 Salvador, BA, Brazil.
⁴ Universidade Estadual de Feira de Santana, Avenida Transnordestina, s/n - Novo Horizonte, 44036-900 Feira de Santana, BA, Brazil.
⁵ Instituto Cegos da Bahia, R. São José de Baixo - Barbalho, 40300-770 Salvador, BA, Brazil.
⁶ UCL Institute for Global Health, University College London, Mortimer Market Centre, Capper street, London WC1 6JB, UK.
⁷ UCL Great Ormond Street Institute of Child Health, GOSH NIHR BRC, 30 Guilford Street, London WC1N 1EH, UK.
⁸ Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy.

Abstract

Background: Despite growing scientific knowledge of Zika virus (ZIKV) infection, questions remain regarding ZIKV infection in pregnancy and congenital ZIKV syndrome (CZS).

Methods: The ZIKAction Paediatric Registry is an international registry of children with documented ZIKV exposure in utero and/or with confirmed or suspected CZS. Its aim is to characterize these children (i.e., clinical, radiological, neurodevelopmental features) and describe outcomes, longer-term sequelae and management through retrospective case note review. This analysis described the maternal and perinatal characteristics of children in the Registry's Bahia arm, assessed their neuroimaging, ophthalmic, hearing and electroencephalography abnormalities by microcephaly classification and reported on hospitalisations. Children born in 2015-2018 and enrolled 2020-2021 in three public health facilities in Salvador were included.

Results: Of 129 (57% female) children, 15 (11·6%) had laboratory-confirmed congenital ZIKV infection and 114 (88·4%) suspected CZS. At delivery, 15 (11·6%) were normocephalic, 30 (23·3%) moderately microcephalic, and 84 (65·1%) severely microcephalic. Median birth head circumference z-score was -3·51 [IQR, -4·69,-2·73]. During follow-up, all children had abnormal neuroimaging, 80·3% (94/117) abnormal electroencephalogram, 62·2% (77/120) ophthalmic abnormalities, and 27·4% (34/124) hearing impairment. Microcephaly classification was significantly associated with gestational age, and ophthalmological and electroencephalography abnormalities. Of 125 children with hospitalisation data, 52 (41·6%) had been hospitalised by most recent follow-up, at median age of 15·8 [4·0, 34·4] months; infections were the leading cause.

Conclusion: Congenital ZIKV infection is an emerging disease with a varied and incompletely understood spectrum. Continued long-term follow-up is essential to understand longer-term prognosis and to inform future health and educational needs.

Keywords: Congenital Zika Syndrome; Microcephaly; Neurodevelopment; Zika Virus.