出生后前5年内的寨卡相关小头畸形

文献信息

中文摘要

目的： 描述寨卡相关小头畸形儿童在出生后前5年内的临床表现和并发症。
方法： 作为小头畸形流行病学研究组儿科队列的一部分，对一组寨卡相关小头畸形儿童进行观察，直至60月龄。
结果： 在181名儿童中，43.1%为男性，77.2%为足月出生。出生体重中位数为2700 g，64.8%被归类为小于胎龄儿。值得注意的是，22.3%在出生后被诊断为小头畸形，48.8%患有严重小头畸形。最常见的表型特征为颅面比例失调（54.1%）、关节挛缩（35.9%）和枕部突出加重（35.5%）。约三分之一（33.1%）存在吞咽困难（n=151，评估时中位年龄为28.2个月），13.3%的儿童接受胃造瘘（中位年龄24个月）。在9.7%的儿童中检测到听力异常（n=93，评估时中位年龄为30个月）。在眼科评估中，30.4%显示视网膜改变，28.5%显示视神经改变；53.4%观察到斜视。在神经系统评估期间（首次评估中位年龄为15.9个月），73.8%存在异常。影像学检查显示，分别有75.3%和64.4%的儿童存在脑室扩大和皮质萎缩。根据临床指征对84名儿童进行了脑电图检查，其中92.9%存在图形改变。在5年期间，62.4%曾住院，主要因呼吸系统问题和癫痫发作。
结论： 该研究强调了寨卡相关小头畸形的严重性。未来研究应优先对这些儿童进行持续系统监测，以了解迟发性表现和并发症（包括死亡）的发生频率和发生时间。

英文摘要

OBJECTIVE: To characterize clinical manifestations and complications of children with Zika-related microcephaly in the first 5 years after birth.
METHODS: A cohort of children with Zika-related microcephaly were observed up to age 60 months as part of the Microcephaly Epidemic Research Group Pediatric Cohort.
RESULTS: Among the 181 children, 43.1% were male and 77.2% were born at term. The median birth weight was 2700 g, with 64.8% classified as small for gestational age. Notably, 22.3% were diagnosed with microcephaly after birth, and 48.8% had severe microcephaly. Most common phenotypic characteristics were craniofacial disproportion (54.1%), arthrogryposis (35.9%), and exacerbated occipital protuberance (35.5%). Approximately one-third (33.1%) presented with dysphagia (n = 151 evaluated at median age of 28.2 months), and 13.3% of children had gastrostomies (median age of 24 months). Hearing anomalies were detected in 9.7% (n = 93 evaluated at median age of 30 months). In ophthalmological evaluation, 30.4% showed changes in the retina and 28.5% in the optic nerve; strabismus was observed in 53.4%. During neurological assessment (median age at first assessment of 15.9 months), 73.8% presented with abnormalities. Imaging examinations showed ventriculomegaly and cortical atrophy in 75.3% and 64.4% of the children, respectively. Electroencephalography was performed based on clinical indication in 84 children, of whom 92.9% had pattern alterations. Over the 5 years, 62.4% were hospitalized, mainly for respiratory problems and seizures.
CONCLUSIONS: The study highlights the severity of Zika-related microcephaly. Future research should prioritize continued systematic monitoring of these children to understand the frequency and timing of late-onset manifestations and complications, including death.