Children ages 19 months to 24 months with microcephaly and laboratory evidence of Zika virus infection are facing functional and medical challenges across several areas of development, according to CDC's Morbidity and Mortality Weekly Report released last month.  

Report details

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For the report, CDC researchers collaborated with the Brazilian Ministry of Health and other organizations to assess the growth and development of children born in Paraíba state of Brazil between Oct. 1, 2015, and Jan. 31, 2016. The report focuses on a subsample of 19 of the "most severe" cases of infants who were born with microcephaly and had laboratory evidence of Zika virus infection.

The researchers evaluated the children based on clinical evaluations, caregiver interviews, and a review of medical records. Each of the children involved in the report also completed a standardized neurological exam.

Findings

CDC researchers found all 19 children had at least one adverse outcome, including:

• Feeding challenges;
• Seizures;
• Severe motor impairments;
• Sleeping difficulties; and
• Vision and hearing abnormalities.

These challenges tended to co-occur in children, the CDC researchers found.

Specifically, the CDC researchers found:

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• 13 children had impaired responses to visual stimuli;
• 11 children screened positive for nonfebrile seizures, which indicates the possibility of a seizure disorder;
• 10 children frequently experienced difficulty sleep;
• Nine children had challenges with eating and swallowing; and
• Eight children were previously hospitalized—including six children who had bronchitis/pneumonia.

According to the report, 15 of the children did not meet developmental milestones—such as being able to sit up by themselves—under the Ages and Stages Questionnaires for children ages six months. The CDC researchers found 15 children had Hammersmith Infant Neurological Examination scores that indicate severe motor impairments, of which 14 had scores consistent with cerebral palsy, the researchers found.

Four of the children showed very few symptoms and typical development and growth patterns, which Cynthia Moore, CMO in CDC's division of congenital and development disorders, said indicates they were mistakenly identified as having Zika-related microcephaly at birth.

Implications

CDC Director Brenda Fitzgerald said, "We would expect that these children are going to require enormous amounts of work and require enormous amounts of care." For instance, CDC researchers in the report wrote that "the data allow for [the] 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 health care and community settings."

Moore said CDC plans to monitor the development of U.S. babies born with Zika-related microcephaly to better understand the effects of the Zika virus. She said, "We do not know the spectrum of problems that can happen with Zika virus infection congenitally or in utero" and "[w]e don't know the end of it" (Branswell, STAT News, 12/14; Belluck, New York Times, 12/14; CDC's Morbidity and Mortality Weekly Report, 12/15).

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