Abstract
ObjectiveTo assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil.MethodsWe contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than −3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2.FindingsBetween 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2–8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012.ConclusionThe numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.
Highlights
Congenital microcephaly is a neurological condition defined by an occipital-frontal head circumference that is smaller than expected for the gestational age and gender
Notes: Nurses retrieved data on head circumference for 10% of neonates participating in the paediatric cardiology network in Paraíba
When projecting our findings to the total number of live births in Paraíba in 2014 (n = 58 147), if we use the proposed criterion from the health ministry, the estimated number of neonates born with microcephaly in that year is 4652; if we use the Fenton curves, the estimated number is 2442; and if we use the proportionality criterion, the estimated number is 2907
Summary
Congenital microcephaly is a neurological condition defined by an occipital-frontal head circumference that is smaller than expected for the gestational age and gender. Head circumference is a validated measurement for intracranial brain volume, since the growth of the cranium depends on the forces of the expanding brain. Could, be used as an indicator of an undersized brain. Controversy exists concerning the suitable lower limit for this measurement, as well as over the need for ethnically controlled data.[1] establishing the clinical implications of an undersized brain is difficult. Common causes of microcephaly are genetic disorders, severe malnutrition during pregnancy and intrauterine infections – such as syphilis and toxoplasmosis
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