Understanding the multidimensional neurodevelopmental outcomes in children after congenital Zika virus exposure
Sarah B Mulkey1,2,3, Meagan E Williams4, Colleen Peyton5
1Children's National Hospital, Washington, DC, USA. SBMULKEY@childrensnational.org.
Insights
Children exposed to Zika virus (ZIKV) in utero, even without congenital Zika syndrome (CZS), may experience neurodevelopmental differences. Longitudinal follow-up and multi-domain assessments are crucial for supporting these children.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Infectious Diseases
Background:
- International research since 2016 focuses on outcomes for children with in utero Zika virus (ZIKV) exposure.
- Congenital Zika syndrome (CZS) affects up to 10% of exposed children, but others may also show neurodevelopmental differences.
- Longitudinal follow-up is recommended for all ZIKV-exposed children.
Purpose of the Study:
- To review neurodevelopmental phenotypes in infants and children with antenatal ZIKV exposure.
- To present a multidimensional framework (ICF model) and multi-domain toolboxes for assessing ZIKV-exposed children.
- To describe neurodevelopmental care strategies supporting the health and well-being of these children.
Main Methods:
- Literature review summarizing neurodevelopmental outcomes.
- Presentation of a whole-child, interdisciplinary framework (ICF model).
- Introduction of multi-domain ZIKV Outcome Toolboxes for ages 0-12 years, incorporating parent questionnaires and child evaluations.
Main Results:
- Antenatal ZIKV exposure is associated with a range of neurodevelopmental differences, not limited to CZS.
- A comprehensive, multidimensional approach is needed to understand outcomes in context.
- Toolboxes facilitate longitudinal, multi-domain assessments internationally.
Conclusions:
- Neurodevelopmental care for ZIKV-exposed children requires a whole-child perspective.
- Multi-domain toolboxes, telehealth, and neuroimaging enhance assessment and understanding.
- Strategies are applicable to other congenital exposures impacting neurodevelopment.
Abstract:
Since 2016, international research groups have focused on assessing outcomes of children with in utero Zika virus (ZIKV) exposure. While the more severe outcomes of congenital Zika syndrome (CZS) occur in up to 10% of children with antenatal exposure, early findings among ZIKV-exposed children without CZS ages 0-5 years suggest that they may also have differences in multiple domains of neurodevelopment. Thus, longitudinal follow-up of all children with antenatal ZIKV exposure has been recommended. This review presents a summary of neurodevelopmental phenotypes of infants and children following antenatal ZIKV exposure. We present a multidimensional framework to understand child neurodevelopment from an interdisciplinary and whole-child perspective (International Classification of Functioning, Disability and Health model) and multi-domain ZIKV Outcome Toolboxes. The toolboxes are for clinicians, researchers, child educators, and others to implement longitudinal multi-domain neurodevelopmental assessments between ages 0-12 years. Recent innovations in telehealth and neuroimaging can help evaluate outcomes in ZIKV exposed children. The objective is to describe the multiple facets of neurodevelopmental focused care that can support the health, function, and well-being of children with antenatal ZIKV exposure. The research and clinical follow-up strategies are applicable to ZIKV and other congenital infectious or environmental exposures that can impact child neurodevelopment. IMPACT: International longitudinal cohort studies have revealed a range of differences in neurodevelopment among children with antenatal Zika virus (ZIKV) exposure. A multidimensional and whole-child framework is necessary to understand the neurodevelopment of children with antenatal ZIKV exposure in relation to family life, community participation, and environment. Multi-domain toolboxes that utilize parent questionnaires and child evaluations are presented. These toolboxes can be used internationally alongside telehealth, brain imaging, and other innovations to improve understanding of child outcomes.
