Gaspari C1, Freire R1, Jaccoud AC1, Albuquerque L1, Darragh A2, Campo M3
1Instituto Estadual do Cerebro Paulo Niemeyer, Physical Therapy, Rio de Janeiro, Brazil, 2Ohio State University, Occupational Therapy, Columbus, United States, 3Mercy College, Physical Therapy, Dobbs Ferry, United States
Background: In 2016 the World Health Organization (WHO) declared the Zika Virus (ZIKV) a global public health emergency when an association with congenital microcephaly was established. Recent studies have contributed tremendous knowledge to the epidemiology of ZIKV, but studies of its clinical manifestations, consequences, and management are desperately needed.
In 2015, Instituto Estadual do Cérebro Paulo Niemeyer was selected to become an interdisciplinary evaluation center for the screening of all children with congenital microcephaly in the State of Rio de Janeiro during the epidemic.
Purpose: The purpose of this study is to describe the clinical features of children with congenital microcephaly, as determined by physical therapy (PT) evaluation, in the State of Rio de Janeiro during the ZIKV epidemic.
Methods: This retrospective, observational study involved children with suspected in-utero exposure to ZIKV who were evaluated between March 2016 and March 2017 in Instituto Estadual do Cérebro Paulo Niemeyer, Brazil.. The variables of interest included demographic characteristics (age, sex and gestational age), maternal ZIKV symptoms, cephalic perimeter, neurological status (muscle tone, motor reflexes, neurodevelopmental milestone), motor behavioral, and musculoskeletal integrity. Findings were recorded in the electronic medical record and then later extracted by the primary investigator for data analysis.
Results: A total of 250 mother/child pairs were evaluated. The mean (SD) age of birth was 37.8 (2.4) weeks with median (IQR) age of 91 (95) days. Most of the mothers (82.8%) reported Zika-like symptoms during pregnancy. The mean (SD) gestational age of symptoms for those who reported Zika-like symptoms was 4.1 (4.5) months. Using the WHO standard of 2 standard deviations below the median for age and gender, 162 the babies (65.3%) were classified as microcephalic at birth. Out of the babies 4 months or older (n=86), 61 (71%) were determined to have motor delay according to Brazilian Motor Development Guidelines. Most of the babies were active (90.4%) and calm (62.4%). One hundred fifty-five (62%) of the infants exhibited abnormal muscle tone. One hundred thirty four (54%) of the infants were hypertonic, while 21 (8%) were hypotonic. Twenty three (9%) of the infants had one or more orthopedeic abnormalities (hip, knee, or wrist).
Conclusion(s): This paper provides a clinical description of the infants with microcephalus secondary to ZIKV in a reference health institution in Brazil during the 2016 epidemic. Microcephalus was the most common clinical manifestation occurring in almost two-thirds of the children. Other clinical features occurring in majority of children with ZIKV were hypertonicity and delayed motor functional milestone. Orthopaedic abnormalities and motor behavioral abnormalites were sparingly present.
Implications: This effort provides a unique opportunity to describe the results of physical therapy evaluations performed at the height of the epidemic of an emerging disease about which very little information was available.
Keywords: Zika Virus, Microcephaly, Epidemic
Funding acknowledgements: None
In 2015, Instituto Estadual do Cérebro Paulo Niemeyer was selected to become an interdisciplinary evaluation center for the screening of all children with congenital microcephaly in the State of Rio de Janeiro during the epidemic.
Purpose: The purpose of this study is to describe the clinical features of children with congenital microcephaly, as determined by physical therapy (PT) evaluation, in the State of Rio de Janeiro during the ZIKV epidemic.
Methods: This retrospective, observational study involved children with suspected in-utero exposure to ZIKV who were evaluated between March 2016 and March 2017 in Instituto Estadual do Cérebro Paulo Niemeyer, Brazil.. The variables of interest included demographic characteristics (age, sex and gestational age), maternal ZIKV symptoms, cephalic perimeter, neurological status (muscle tone, motor reflexes, neurodevelopmental milestone), motor behavioral, and musculoskeletal integrity. Findings were recorded in the electronic medical record and then later extracted by the primary investigator for data analysis.
Results: A total of 250 mother/child pairs were evaluated. The mean (SD) age of birth was 37.8 (2.4) weeks with median (IQR) age of 91 (95) days. Most of the mothers (82.8%) reported Zika-like symptoms during pregnancy. The mean (SD) gestational age of symptoms for those who reported Zika-like symptoms was 4.1 (4.5) months. Using the WHO standard of 2 standard deviations below the median for age and gender, 162 the babies (65.3%) were classified as microcephalic at birth. Out of the babies 4 months or older (n=86), 61 (71%) were determined to have motor delay according to Brazilian Motor Development Guidelines. Most of the babies were active (90.4%) and calm (62.4%). One hundred fifty-five (62%) of the infants exhibited abnormal muscle tone. One hundred thirty four (54%) of the infants were hypertonic, while 21 (8%) were hypotonic. Twenty three (9%) of the infants had one or more orthopedeic abnormalities (hip, knee, or wrist).
Conclusion(s): This paper provides a clinical description of the infants with microcephalus secondary to ZIKV in a reference health institution in Brazil during the 2016 epidemic. Microcephalus was the most common clinical manifestation occurring in almost two-thirds of the children. Other clinical features occurring in majority of children with ZIKV were hypertonicity and delayed motor functional milestone. Orthopaedic abnormalities and motor behavioral abnormalites were sparingly present.
Implications: This effort provides a unique opportunity to describe the results of physical therapy evaluations performed at the height of the epidemic of an emerging disease about which very little information was available.
Keywords: Zika Virus, Microcephaly, Epidemic
Funding acknowledgements: None
Topic: Paediatrics; Disaster management
Ethics approval required: Yes
Institution: Instituto Estadual do Cerebro Paulo Niemeyer
Ethics committee: Instituto Estadual do Cerebro Paulo Niemeyer Ethics Committee
Ethics number: 69917617.5.0000.8110
All authors, affiliations and abstracts have been published as submitted.
