Gross Motor Function in Children with Congenital Zika Syndrome
Background Little information on gross motor function of congenital Zika syndrome (CZS) children is available.
Objectives To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months.
Methods One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed.
Results Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4–10.8); and the median GMFM-66 score was 20.5 (14.8–23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20–55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed.
Conclusions Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.
Table of Contents Summary
Gross motor function and its associated factors of 100 children with confirmed or presumed CZS were evaluated. Forty-six children were reevaluated in a minimum interval of 6 months.
Ms. Eliana Harumi Morioka Takahasi conceived and designed the study, collected the data on motor function, performed the analysis, drafted the initial manuscript. Professor Maria Teresa Seabra Soares de Britto e Alves, Professor Marizélia Rodrigues Costa Ribeiro and Professor Vanda Maria Ferreira Simões conceived and designed the study, revised the work critically for important intellectual content, and approved the final version to be submitted. Ms. Valéria Ferreira Pereira Souza collected the data on motor function, revised the work critically for important intellectual content, and approved the final version to be submitted. Gláucio Andrade Amaral and Marcella Costa Ribeiro Borges collected the data on neuroimaging findings, revised the work critically for important intellectual content, and approved the final version to be submitted. Ms. Lillian Nunes Gomes and Professor Ricardo Khouri collected the data on the laboratory confirmation of Zika virus infection, revised the work critically for important intellectual content, and approved the final version to be submitted. Dr. Patricia da Silva Sousa collected the data on clinical diagnosis and neurological symptoms of the sample, contributed to analysis and interpretation of data, revised the work critically for important intellectual content, and approved the final version to be submitted. Professor Antonio Augusto Moura da Silva is the main researcher of the project “Congenital Zika syndrome,” conceived and designed the study, coordinated and supervised data collection, contributed to analysis and interpretation of data, revised the work critically for important intellectual content, and approved the final version to be submitted. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Eingereicht: 04. Mai 2020
Angenommen: 31. August 2020
27. Oktober 2020 (online)
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- 1 Brito C. Zika virus: a new chapter in the history of medicine. Acta Med Port 2015; 28 (06) 679-680
- 2 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects--reviewing the evidence for causality. N Engl J Med 2016; 374 (20) 1981-1987
- 3 WHO. WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Accessed September 16, 2020 at: http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/
- 4 Del Campo M, Feitosa IML, Ribeiro EM. et al; Zika Embryopathy Task Force-Brazilian Society of Medical Genetics ZETF-SBGM. The phenotypic spectrum of congenital Zika syndrome. Am J Med Genet A 2017; 173 (04) 841-857
- 5 Abuali M, Domachowske J. Congenital and perinatal infections. In: Domachowske J. ed. Introduction to Clinical Infectious Diseases. Springer, Cham; 2019: 213-224
- 6 Collins MH, Waggoner JJ. Detecting vertical Zika transmission: emerging diagnostic approaches for an emerged flavivirus. ACS Infect Dis 2019; 5 (07) 1055-1069
- 7 Ximenes RAA, Miranda-Filho DB, Brickley EB. et al; Microcephaly Epidemic Research Group (MERG). Zika virus infection in pregnancy: establishing a case definition for clinical research on pregnant women with rash in an active transmission setting. PLoS Negl Trop Dis 2019; 13 (10) e0007763
- 8 Carvalho A, Brites C, Mochida G. et al. Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika. Brain Dev 2019; 41 (07) 587-594
- 9 Melo A, Gama GL, Da Silva Júnior RA. et al. Motor function in children with congenital Zika syndrome. Dev Med Child Neurol 2020; 62 (02) 221-226
- 10 Moura da Silva AA, Ganz JSS, Sousa PD. et al. Early growth and neurologic outcomes of infants with probable congenital Zika virus syndrome. Emerg Infect Dis 2016; 22 (11) 1953-1956
- 11 Ventura PA, Lage MLC, de Carvalho AL, Fernandes AS, Taguchi TB, Nascimento-Carvalho CM. Early gross motor development among Brazilian children with microcephaly born right after Zika virus infection outbreak. J Dev Behav Pediatr 2020; 41 (02) 134-140
- 12 Alves LV, Paredes CE, Silva GC, Mello JG, Alves JG. Neurodevelopment of 24 children born in Brazil with congenital Zika syndrome in 2015: a case series study. BMJ Open 2018; 8 (07) e021304
- 13 Nielsen-Saines K, Brasil P, Kerin T. et al. Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children. Nat Med 2019; 25 (08) 1213-1217
- 14 França TLB, Medeiros WR, Souza NL. et al. Growth and development of children with microcephaly associated with congenital zika virus syndrome in Brazil. Int J Environ Res Public Health 2018; 15 (09) E1990
- 15 Marques FJP, Teixeira MCS, Barra RR. et al. Children born with congenital Zika syndrome display atypical gross motor development and a higher risk for cerebral palsy. J Child Neurol 2019; 34 (02) 81-85
- 16 Pessoa A, van der Linden V, Yeargin-Allsopp M. et al. Motor abnormalities and epilepsy in infants and children with evidence of congenital Zika virus infection. Pediatrics 2018; 141 (Suppl. 02) S167-S179
- 17 Moore CA, Staples JE, Dobyns WB. et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr 2017; 171 (03) 288-295
- 18 Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The Gross Motor Function Measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989; 31 (03) 341-352
- 19 Frota LMDCP, Sampaio RF, Miranda JL. et al. Children with congenital Zika syndrome: symptoms, comorbidities and gross motor development at 24 months of age. Heliyon 2020; 6 (06) e04130
- 20 Massetti T, Herrero D, Alencar J. et al. Clinical characteristics of children with congenital Zika syndrome: a case series. Arq Neuropsiquiatr 2020; 78 (07) 403-411
- 21 Baer A, Kehn-Hall K. Viral concentration determination through plaque assays: using traditional and novel overlay systems. J Vis Exp 2014; (93) e52065
- 22 Brasil, Ministério da Saúde, Secretaria de Vigilância em Saúde, Secretaria de Atenção à Saúde. Orientações Integradas de Vigilância e Atenção à Saúde No Âmbito Da Emergência de Saúde Pública de Importância Nacional: Procedimentos Para o Monitoramento Das Alterações No Crescimento e Desenvolvimento a Partir Da Gestação Até a Primeira Infância, Relac. 2017 . Accessed September 16, 2020 at: http://portalarquivos.saude.gov.br/images/pdf/2016/dezembro/12/orientacoes-integradas-vigilancia-atencao.pdf
- 23 World Health Organization. Screening, assessment and management of neonates and infants with complications associated with Zika virus exposure in utero: Rapid Advice Guideline. World Heal Organ. 2016 (WHO/ZIKV/MOC/16.3/Rev3):15. Accessed September 16, 2020 at: http://apps.who.int/iris/bitstream/10665/204475/1/WHO_ZIKV_MOC_16.3_eng.pdf?ua=1
- 24 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (04) 214-223
- 25 Hiratuka E, Matsukura TS, Pfeifer LI. Cross-cultural adaptation of the gross motor function classification system into Brazilian-Portuguese (GMFCS). Rev Bras Fisioter 2010; 14 (06) 537-544
- 26 Russell DJ, Rosenbaum PL, Wright M, Avery LM. Medida Da Função Motora Grossa [Livro Eletrônico]: [GMFM-88 & GMFM-66]: Manual Do Usuário. 2a edição.. São Paulo: Memnon; 2015
- 27 Hanna SE, Bartlett DJ, Rivard LM, Russell DJ. Reference curves for the gross motor function measure: percentiles for clinical description and tracking over time among children with cerebral palsy. Phys Ther 2008; 88 (05) 596-607
- 28 Associação Brasileira de Empresas Pesquisa - ABEP. Critério de Classificação Econômica Brasil [Internet]. São Paulo: Associação Brasileira de Empresas Pesquisa - ABEP; 2015. Available at: http://www.abep.org/criterio-brasil. Accessed May 1, 2020
- 29 Villar J, Cheikh Ismail L, Victora CG. et al; International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014; 384 (9946): 857-868
- 30 The Definition and Classification of Cerebral Palsy Contents Foreword Historical Perspective Definition and Classification Document. The definition and classification of cerebral palsy. Dev Med Child Neurol 2007; 49 (s109) 1-44
- 31 Rosenbaum PL, Walter SD, Hanna SE. et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA 2002; 288 (11) 1357-1363
- 32 Zare Mehrjardi M, Poretti A, Huisman TAGM, Werner H, Keshavarz E, Araújo JúniorE. Neuroimaging findings of congenital Zika virus infection: a pictorial essay. Jpn J Radiol 2017; 35 (03) 89-94
- 33 Marques VM, Santos CS, Santiago IG. et al. Neurological complications of congenital Zika virus infection. Pediatr Neurol 2019; 91: 3-10
- 34 De Góes Cavalcanti LP, Tauil PL, Alencar CH, Oliveira W, Teixeira MM, Heukelbach J. Zika virus infection, associated microcephaly, and low yellow fever vaccination coverage in Brazil: is there any causal link?. J Infect Dev Ctries 2016; 10 (06) 563-566
- 35 Nogueira FC, Velasquez E, Melo AS, Domont GB. Zika virus may not be alone: proteomics associates a bovine-like viral diarrhea virus to microcephaly. Bio Rxiv 2016; 16: 062596
- 36 Ferreira HNC, Schiariti V, Regalado ICR. et al. Functioning and disability profile of children with microcephaly associated with congenital Zika virus infection. Int J Environ Res Public Health 2018; 15 (06) E1107
- 37 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus Zika / Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. – Brasília: Ministério da Saúde, 2015