False negatives: Delayed Zika effects in babies who appeared normal at birth

January 06, 2020

Colombian infants exposed to Zika virus in the womb showed neurodevelopmental delays as toddlers, despite having "normal" brain imaging and head circumference at birth, a finding that underscores the importance of long-term neurodevelopmental follow-up for Zika-exposed infants, according to a study published online Jan. 6, 2020, in JAMA Pediatrics.

"These infants had no evidence of Zika deficits or microcephaly at birth. Neurodevelopmental deficits, including declines in mobility and social cognition, emerged in their first year of life even as their head circumference remained normal," says Sarah B. Mulkey, M.D. Ph.D., a fetal/neonatal neurologist at Children's National Hospital and the study's first author. "

About one-third of these newborns who underwent postnatal head ultrasound had nonspecific imaging results, which we believe are the first published results finding a link between subtle brain injuries and impaired neuromotor development in Zika-exposed children."

The multi-institutional research group led by Children's National enrolled pregnant women in Atlántico Department, which hugs the Caribbean coast of Colombia, who had been exposed to Zika, and performed a series of fetal magnetic resonance images (MRI) and ultrasounds as their pregnancies progressed.

Even though their mothers had laboratory-confirmed Zika infections, 77 out of 82 of their offspring were born with no sign of congenital Zika syndrome, a constellation of birth defects that includes severe brain abnormalities, eye problems and congenital contractures, and 70 underwent additional testing of neurodevelopment during infancy. These apparently normal newborns were born between Aug. 1, 2016, and Nov. 30, 2017, at the height of the Zika epidemic, and had normal head circumference.

When they were 4 to 8 months or 9 to 18 months of age, the infants' neurodevelopment was evaluated using two validated tools, the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (a 50-item test of such skills as self-care, mobility, communication and social cognition) and the Alberta Infant Motor Scale (a motor examination of infants in prone, supine, sitting and standing positions). Some infants were assessed during each time point.

Women participating in the study were highly motivated, with 91% following up with appointments, even if it meant traveling hours by bus. In addition to Children's National faculty traveling to Colombia to train staff how to administer the screening instruments, videotaped assessments, MRIs and ultrasounds were read, analyzed and scored at Children's National. According to the study team, the U.S. scoring of Alberta Infant Motor Scale tests administered in Colombia is also unprecedented for a research study and offers the potential of remote scoring of infants' motor skill maturity in regions of the world where pediatric specialists, like child neurologists, are lacking.

"Normally, neurodevelopment in infants and toddlers continues for years, building a sturdy neural network that they later use to carry out complex neurologic and cognitive functions as children enter school," Dr. Mulkey adds. "Our findings underscore the recommendations by the Centers for Disease Control and Prevention that all infants exposed to Zika in the womb undergo long-term follow-up, providing an opportunity to intervene earlier."
-end-
In addition to Dr. Mulkey, study co-authors include Margarita Arroyave-Wessel, MPH, Dorothy I. Bulas, M.D., chief of Diagnostic Imaging and Radiology, JiJi Jiang, MS, Stephanie Russo, BS, Robert McCarter, ScD, research section head, design and biostatistics, Adré J. du Plessis, M.B.Ch.B., MPH, chief of the Division of Fetal and Transitional Medicine, and co-Senior Author, Roberta L. DeBiasi, MD, MS, chief of the Division of Pediatric Infectious Diseases, all of Children's National; Colleen Peyton, PT, DPT, of Northwestern University; Yamil Fourzali, M.D., of Sabbag Radiologos, Barranquilla, Colombia; Michael E. Msall, M.D., of University of Chicago Comer Children's Hospital; and co-Senior Author, Carlos Cure, M.D., BIOMELab, Barranquilla, Colombia.

Funding for the research described in this post was provided by the Thrasher Research Fund, the National Institutes of Health under award Nos. UL1TR001876 and KL2TR001877, and the Leadership Education in Neurodevelopmental and Related Disorders Training Program under grant HRSA/MCHB T73 MC11047.

Children's National Hospital

Related Infants Articles from Brightsurf:

Most infants are well even when moms are infected by COVID-19
Infants born to women with COVID-19 showed few adverse outcomes, according to the first report in the country of infant outcomes through eight weeks of age.

Probiotic may help treat colic in infants
Probiotics -- or 'good bacteria' -- have been used to treat infant colic with varying success.

Deaf infants' gaze behavior more advanced than that of hearing infants
Deaf infants who have been exposed to American Sign Language are better at following an adult's gaze than their hearing peers, supporting the idea that social-cognitive development is sensitive to different kinds of life experiences.

Initiating breastfeeding in vulnerable infants
The benefits of breastfeeding for both mother and child are well-recognized, including for late preterm infants (LPI).

Young infants with fever may be more likely to develop infections
Infants with a high fever may be at increased risk for infections, according to research from Penn State College of Medicine.

Early term infants less likely to breastfeed
A new, prospective study provides evidence that 'early term' infants (those born at 37-38 weeks) are less likely than full-term infants to be breastfeed within the first hour and at one month after birth.

Infants are more likely to learn when with a peer
Researchers at the University of Connecticut and University of Washington looked at the mechanisms involved in language learning among nine-month-olds, the youngest population known to be studied in relation to on-screen learning.

Allergic reactions to foods are milder in infants
Majority of infants with food-induced anaphylaxis present with hives and vomiting, suggesting there is less concern for life-threatening response to early food introduction.

Non-dairy drinks can be dangerous for infants
A brief report published in Acta Paediatrica points to the dangers of replacing breast milk or infant formula with a non-dairy drink before one year of age.

Infants can't talk, but they know how to reason
A new study reveals that preverbal infants are able to make rational deductions, showing surprise when an outcome does not occur as expected.

Read More: Infants News and Infants Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.