January 30, 2020
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Zika-exposed infants without congenital Zika syndrome at risk for abnormal neurodevelopment

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Sarah B. Mulkey, MD, PhD
Sarah B. Mulkey

Infants without congenital Zika syndrome who were exposed to Zika in utero are at risk for abnormal neurodevelopmental outcomes during their first 18 months of life, according to a longitudinal study published in JAMA Pediatrics.

“Women should take care during pregnancy to avoid mosquito bites and other known Zika transmission routes if they live in a location at risk for Zika or if they are traveling to a location with circulating Zika virus,” Sarah B. Mulkey, MD, PhD, a fetal and neonatal neurologist at Children’s National Hospital, told Healio.

There are no ongoing Zika outbreaks anywhere in the world, but the CDC recommends that pregnant women or women planning on becoming pregnant talk to their health care provider before traveling to areas where current or past transmission of the virus has been documented.

“Women also may consider alternative travel plans during pregnancy to avoid risk of Zika exposure. Women can consult the CDC travel website to learn about risk in different areas,” Mulkey added.

Mulkey and colleagues examined the neurodevelopment of 77 Zika-exposed Colombian infants born between Aug. 1, 2016, and Nov. 30, 2017. They included infants who were live born, were normocephalic at birth, had normal fetal brain findings on MRI and ultrasonography and had normal examination results without any clinical evidence of Zika.

They assessed neurodevelopment using the Warner Initial Developmental Evaluation of Adaptive and functional Skills and the Alberta Infant Motor Scale at one or two time points from 4 and 18 months of age.

Of the 77 Zika-exposed infants, 70 were uninfected with the virus. Of the 70 uninfected infants, multidomain neurodevelopmental assessment scores deviated from the norm as the children aged. Domain scores for communication (–0.036; P = .001), social cognition (–0.1; P < .001) and mobility (–0.14; P = .001) showed linear declines with increasing age, the researchers reported.

Mulkey noted the study’s largest limitation was a lack of a non-Zika-exposed control group and emphasized that the norms for the assessments were not from Colombian children.

“For future studies, the inclusion of a comparable control cohort would help with this limitation or the use of a neurodevelopmental assessment tool with prior validation in Colombian children pre-Zika virus,” she said.

Mulkey also suggested health care providers consider the longitudinal effects of Zika exposure among their patients.

“Clinicians should continue to think about Zika virus and the potential for long-term effects in their patients,” Mulkey said. “When a clinician sees a child with a developmental delay, the clinician should think about the possibility of Zika exposure. The mother may be unaware that she had Zika infection during pregnancy because up to 80% of infections are asymptomatic.” – by Eamon Dreisbach

Disclosures: Mulkey reports receiving grants from the Thrasher Research Fund during the conduct of the study and providing technical expertise to the Zika studies by the CDC outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.