PT  - JOURNAL ARTICLE
AU  - Karen Blackmon
AU  - Roberta Evans
AU  - Michelle Fernandes
AU  - Barbara Landon
AU  - Trevor Noel
AU  - Calum Macpherson
AU  - Nikita Cudjoe
AU  - Kemi S Burgen
AU  - Bianca Punch
AU  - Amy Krystosik
AU  - Elysse N Grossi-Soyster
AU  - Angelle Desiree LaBeaud
AU  - Randall Waechter
TI  - Neurodevelopment in normocephalic children with and without prenatal Zika virus exposure
AID  - 10.1136/archdischild-2020-321031
DP  - 2021 Sep 03
TA  - Archives of Disease in Childhood
PG  - archdischild-2020-321031
4099  - http://adc.bmj.com/content/early/2021/09/10/archdischild-2020-321031.short
4100  - http://adc.bmj.com/content/early/2021/09/10/archdischild-2020-321031.full
AB  - Objective Zika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.Design Cohort study.Setting Public health centres in Grenada, West Indies.Patients 384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measures The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.Results A total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.Conclusions Overall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.Data are available on reasonable request.