Invited commentary by Children’s National prenatal-neonatal neurologist emphasizes importance of learning this inhabitants long term
July 07, 2020
A very simple measuring tape could be the critical to figuring out which young children could establish neurological and developmental abnormalities from Zika virus publicity all through gestation. This is in accordance to an invited commentary revealed July 7 in JAMA Network Open up and written by Sarah Mulkey, M.D., Ph.D., prenatal-neonatal neurologist in the Division of Prenatal Pediatrics at Children’s National Clinic.
Zika virus (ZIKV), 1st isolated in 1947 in the Ziika Forest in Uganda, built headlines in 2015-2016 for creating a popular epidemic that distribute by way of pieces of North and South The us, several islands in the Pacific and pieces of Southeast Asia. While previously linked with no or delicate symptoms, researchers uncovered all through this epidemic that Zika can cross from a expecting woman to her gestating fetus, foremost to a syndrome marked by microcephaly (lessened mind growth), irregular neurologic tone, eyesight and listening to abnormalities, and joint contractures.
“For the ninety{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5} to ninety five{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5} of ZIKV-exposed infants who luckily had been not born with severe abnormalities at start and had been normocephalic, our hope was that these young children would have ordinary neurodevelopmental results,” Dr. Mulkey writes in the commentary. “Unfortunately, this has not been the scenario.”
Her commentary expands on a analyze in the same challenge entitled “Association amongst publicity to antenatal Zika virus and anatomic and neurodevelopmental abnormalities in children” by Cranston et al. In this analyze, the researchers come across that head circumference — a very simple evaluate taken frequently at postnatal appointments in the U.S. — can offer insight into which young children had been most possible to establish neurologic abnormalities. Their results present that sixty eight{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5} of those people whose head circumference was in the “normal” array at start designed neurologic troubles. Those people whose head circumference was at the upper stop of this array had been drastically a lot less possible to have abnormalities than those people at the lower stop.
Just this solitary measurement provides significant insight into the risk of establishing neurologic troubles following Zika publicity. Even so, notes Dr. Mulkey, head circumference growth trajectory is also critical. Of the 162 infants whose heads had been in the beginning in the normocephalic array at start, about 10.5{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5} went on to establish microcephaly in the months following start.
“Because early head growth trajectory is involved with cognitive results in early childhood,” Dr. Mulkey writes, “following the head circumference percentile above time can permit recognition of a youngster with improved risk for very poor result who could benefit from early intervention therapies.”
This very simple assessment could be drastically augmented with neuroimaging, she provides. The analyze by Cranston et al., as perfectly as other people in the discipline, have revealed that mind imaging typically reveals troubles in ZIKV-exposed young children, this sort of as calcifications and cerebral atrophy, even in those people with ordinary head circumferences. This imaging doesn’t always have to have to take put at start, Dr. Mulkey states. Postnatal progress of microcephaly, failure to thrive or developmental hold off can all be triggers for imaging later on on.
Jointly, Dr. Mulkey states, the analyze by Cranston et al. and other people that concentrate on ZIKV-exposed young children help the have to have for next these clients long term. Young children exposed to ZIKV in the epidemic almost 5 yrs back are now approaching college age, a time fraught with more challenging cognitive and social demands. By way of her own study at Children’s National’s Congenital Zika Virus Program and collaboration with colleagues in Colombia, Dr. Mulkey is next numerous cohorts of ZIKV exposed young children as they improve. She not long ago revealed a analyze on neurological abnormalities in a single of these cohorts in JAMA Pediatrics in January 2020.
“It’s actually critical to abide by these young children as long as achievable so we’ll actually know the results of this virus,” Dr. Mulkey states.
Media speak to: Beth Riggs | 301-233-4038