Children with Zika virus–associated microcephaly face ongoing, co-occurring medical and functional difficulties that affect many areas of development, according to a study by the Centers for Disease Control and Prevention.
Ashley Satterfield-Nash, DrPH, Oak Ridge Institute for Science and Education, Tennessee, and colleagues studied a cohort of children who participated in the Zika Outcomes and Development in Infants and Children (ZODIAC) investigation. The findings were published online December 15 in Morbidity and Mortality Weekly Report.
“This report expands on initial findings by demonstrating that specific outcomes, such as severe motor impairment and impaired visual and auditory response to stimuli, affect the majority of children with evidence of congenital Zika virus infection and microcephaly and become more apparent as these children age,” the authors write.
“They will continue to require specialized care from clinicians and caregivers.”
Women infected with Zika virus during pregnancy are at increased risk of giving birth to babies with microcephaly.
However, although the effects of congenital microcephaly during early infancy have been described, the ongoing health and development in these children have not been well characterized, hindering planning for their care as they age.
Dr Satterfield-Nash and colleagues therefore assessed health and development among children older than age 12 months who were born with microcephaly.
They used clinical evaluations, caregiver interviews, and review of medical records to collect data for the study.
They included 19 children, aged 19 to 24 months, who participated in ZODIAC and were born with microcephaly and with laboratory evidence of Zika virus infection.
According to the authors, 15 children had head circumference measurements that were more than 3 standard deviations (SDs) below the mean for their age and sex; 13 had length measurements ranging from 1 to 3 SDs below the mean, and 13 had weight measurements ranging from 1 to more than 3 SDs below the mean for their age and sex.
All 19 children had at least one adverse outcome, including eating or swallowing difficulties (n = 9), sleeping difficulties (n = 10), retinal abnormalities (n = 4), impaired response to visual stimuli (n = 11), impaired response to auditory stimuli (n = 13), and seizures (n = 11).
Fifteen children had developmental performance that had not progressed beyond that typical for a 6-month-old, as indicated by their scores on the Ages and Stages Questionnaires, a parent-reported tool designed to screen children for developmental delays.
Fifteen had severe motor impairment, as indicated by a global score below 40 on the Hammersmith Infant Neurological Examination (HINE), a standardized neurologic exam; HINE scores indicated cerebral palsy in 14 of these children.
“Outcomes including feeding challenges, sleeping difficulties, severe motor impairment, vision and hearing abnormalities, and seizures tended to co-occur,” the authors add.
Although all children had at least one of these outcomes, 12 had three to five of them, and two had all six.
This study showed that many of the conditions present at birth in children with congenital Zika virus infection remain present at ages 19 to 24 months, highlighting the long-term challenges that prevent them from reaching age-appropriate developmental milestones.
These children will need ongoing multidisciplinary care from various pediatric subspecialists, the authors say.
Long-term follow-up and measurement of developmental progression of children with congenital Zika virus infection “allow for anticipation of medical and social services needs of affected children and families, such as early intervention services, and planning for resources to support these families in healthcare and community settings,” the authors conclude.
One author has reported receiving funding through an Interagency Agreement between the United States Agency for International Development and the Centers for Disease Control and Prevention for work on Zika during conduct of the study. The remaining authors have disclosed no relevant financial relationships.
MMWR Morb Mortal Wkly Rep. Published online December 15, 2017. Full text
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