Early Growth Parameters as Predictors of Developmental Delay Among Children Conceived During the 2015-2016 Zika Virus Outbreak in Northeastern Brazil.

Charles E Rose,Flavio Melo,Nevin Krishna,Andre Pessoa,Ashley Satterfield-Nash,Donna Camille Smith,Cynthia A Moore,Jacob Elijah Attell,Ana Carolina Faria E Silva Santelli,Jeanne Bertolli,Isabela Ornelas Pereira,Georgina Peacock,Kim Kotzky

doi:10.3390/tropicalmed5040155

Abstract

Background: Identifying infants with congenital infection for early intervention will likely be challenging in future Zika virus outbreaks. We investigated indicators of risk for developmental delay among children born with and without obvious manifestations of congenital Zika virus infection. Methods: We evaluated 120 children conceived during the 2015−2016 Zika virus outbreak in Paraíba, Brazil. We analyzed data from children at birth; ages 1−7 months and approximately 24 months, using medical records (i.e., anthropometric measurements diagnoses), medical evaluation (i.e., Zika/other laboratory tests, dysmorphic features), and parent report (seizures, developmental delay). We used a Bayesian modeling approach to identify predictors of developmental delay. Results: Head circumference (HC) and length at birth and rates of growth for HC and length at follow-up were consistent across domains of developmental delay; (e.g., for every 1 cm per month decrease in HC growth rate; there was a corresponding decrease in the gross motor z-score). Modeling results indicated that HC and length at birth, and follow-up HC and length rates of growth, were predictive of developmental delay. Conclusion: These findings suggest that accurate measurement and frequent monitoring of HC and length, especially in the first few months of life, may be useful for identifying children possibly congenitally exposed to Zika virus who could benefit from early intervention services.

Highlights

Zika virus infection has waned since the 2015 outbreak began in South America, but has the potential to continue in a cyclical pattern, such as dengue, following the periodicity of population immunity [1,2]
The Zika Outcomes and Development in Infants and Children (ZODIAC) investigation was a follow-up evaluation of children conceived during the 2015−2016 Zika virus outbreak in northeastern Brazil, who had participated in a 2016 case-control study to investigate the association between congenital Zika infection and microcephaly [23]
Our results illustrate that early growth parameters are predictive of developmental delay among children conceived during a Zika virus outbreak and likely exposed to Zika virus in utero, who met anthropometric and/or laboratory criteria for Zika virus infection [24]

Summary

Introduction

Zika virus infection has waned since the 2015 outbreak began in South America, but has the potential to continue in a cyclical pattern, such as dengue, following the periodicity of population immunity [1,2]. Whether the observed less severe neurodevelopmental abnormalities in congenitally exposed children without microcephaly can be attributed to Zika virus infection is an open question. Regardless of etiology, such children may not be identified early enough to benefit maximally from interventions without appropriate developmental monitoring. Identifying infants with congenital infection for early intervention will likely be challenging in future Zika virus outbreaks. Conclusion: These findings suggest that accurate measurement and frequent monitoring of HC and length, especially in the first few months of life, may be useful for identifying children possibly congenitally exposed to Zika virus who could benefit from early intervention services

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