Neurodevelopment in normocephalic children with and without prenatal Zika virus exposure

• Published in: Archives of disease in childhood 2022-03, Vol.107 (3), p.244-250
• Main Authors: Blackmon, Karen, Evans, Roberta, Fernandes, Michelle, Landon, Barbara, Noel, Trevor, Macpherson, Calum, Cudjoe, Nikita, Burgen, Kemi S, Punch, Bianca, Krystosik, Amy, Grossi-Soyster, Elysse N, LaBeaud, Angelle Desiree, Waechter, Randall
• Format: Article
• Language: English
• Subjects: Acuity; Adult; Age; Brain - growth & development; Child Development; Child, Preschool; Children; Children & youth; Cognitive ability; Cohort Studies; Control Groups; Cross Cultural Studies; Dengue fever; Developmental Delays; Education; Family income; Female; Females; Food security; Global Child Health; Households; Humans; Infant; Infants; Infections; Infectious Disease Transmission, Vertical; Interviews; Laboratories; Male; Measurement Techniques; Medical imaging; Microcephaly; Microcephaly - epidemiology; Mothers; neonatology; Neural stem cells; Neurodevelopment; neurology; ophthalmology; Parent educational background; Pediatrics; Pregnancy; Pregnancy Complications, Infectious - virology; Prenatal experience; Prenatal Exposure Delayed Effects - virology; Prospective Studies; psychology; Public health; Questionnaires; Reference Groups; Skill Development; Sociodemographics; Stem cells; Toddlers; Vector-borne diseases; virology; Viruses; Vision; Visual Acuity; Visual system; West Indies; Young Children; Zika Virus; Zika Virus Infection - transmission
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-321031

ObjectiveZika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.DesignCohort study.SettingPublic health centres in Grenada, West Indies.Patients384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measuresThe INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.ResultsA total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.ConclusionsOverall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.