Zika-related microcephaly at five years: high rates of dysphagia, eye disease and admission

Design

Prospective cohort (MERG Pediatric Cohort)

Population

181 children with Zika-related microcephaly, Brazil, followed to 60 months

Primary outcome

Clinical manifestations and complications over 5 years

Effect

Dysphagia 33%; gastrostomy 13%; strabismus 53%; hospital admission 62%

This Brazilian cohort, published in Pediatrics on 28 October, followed 181 children with Zika-related microcephaly from the 2015–16 epidemic to five years of age. Almost half had severe microcephaly, and in 22% it was diagnosed only after birth. Two-thirds were small for gestational age.

The burden was wide. A third had dysphagia, and 13% needed a gastrostomy, at a median age of two years. Retinal changes were found in 30%, optic nerve changes in 29% and strabismus in 53%. Hearing abnormalities were found in about 10% of those tested. Most had abnormal neurological examinations, ventriculomegaly and cortical atrophy, and almost all EEGs done for clinical reasons were abnormal. Over five years, 62% were admitted to hospital, mainly for respiratory illness and seizures.

Zika has circulated in India, with outbreaks reported in several states. Most children infected in utero will not have microcephaly, but for those who do, this cohort describes the follow-up they need. Microcephaly can be missed at birth, so head circumference needs rechecking.

• Measure and plot head circumference at birth and at each early review; microcephaly may not be apparent at delivery.
• Children with congenital microcephaly need swallowing assessment early, before aspiration pneumonia occurs.
• Arrange eye examination and hearing assessment for every child with congenital microcephaly.
• Plan seizure management and respiratory care with families, as these drive most admissions.
• Ask about fever and rash during pregnancy, and travel or local outbreaks, when microcephaly is found.

Why it matters

It sets out the complications families and paediatricians must plan for, many of which can be anticipated.

The statistics, in plain English

These are descriptive proportions from one cohort without a comparison group; some tests were done only when clinically indicated, which can overstate how common abnormalities are.

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