Cerebral Palsy in Children With Congenital Zika Syndrome: A 2-Year Neurodevelopmental Follow-up
Cerebral Palsy in Children With Congenital Zika Syndrome: A 2-Year Neurodevelopmental Follow-up
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DOI：
10.1177/0883073819885724
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发表时间：
2019-11-13
影响因子：
1.9
通讯作者：
Lucena, Rita
中科院分区：
文献类型：
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作者：
de Carvalho, Alessandra Lemos;Ventura, Paloma;Lucena, Rita
目的：描述与先天性寨卡病毒(CZ)相关的脑性瘫痪儿童2年的神经发育结果，并探讨与更严重的症状相关的变量。方法：收集69例脑性瘫痪合并CZ患儿的资料，均在一家神经康复医院接受随访，2岁时连续接受神经发育评估。采用Bayley III婴幼儿发育评定量表、Hammersmith婴幼儿神经学检查和粗大运动功能分级系统进行疗效评价。进行描述性和推断性统计分析。结果：中位年龄为24.0(23-32)个月。仅有3例(4.3%)儿童无小头畸形。主要表现为双侧(94.2%)、痉挛(100.0%)、粗大运动功能分级系统IV级或V级(92.8%)、脑性瘫痪、癫痫(73.1%)、认知(94.2%)、语言(95.7%)和运动(95.7%)。Hammersmith婴儿神经学检查评分中位数为21.0(范围9-75)。出生头围与认知(r=0.3，P<；.01)、语言(r=0.3，P<；.01)、运动(r=0.3，P<；.01)Bayley-III婴幼儿发育测验评分以及Hammersmith婴儿神经学检查分数(r=0.2，P<；.03)呈正相关。观察到Hammersmith婴儿神经学检查评分与先天性小头畸形(P=.04)、关节畸形(P=.02)和第一年的癫痫(P<；.01)相关。结论：CZ相关的脑性瘫痪患者在2年的随访中表现出严重的全身性损害。出生头围、关节畸形和早期癫痫与较差的预后相关，可被认为是预后的标志。这些发现对神经康复计划、父母的指导和未来的预后研究都很重要。
Objective: To describe the 2-year neurodevelopmental outcome in children with cerebral palsy associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Methods: Data on 69 children with cerebral palsy associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development, Hammersmith Infant Neurological Examination, and Gross Motor Function Classification System were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. Results: The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%), spastic (100.0%), Gross Motor Function Classification System grade IV or V (92.8%) cerebral palsy, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%), and motor (95.7%) Bayley-III Scales of Infant and Toddler Development Test scores. The median Hammersmith Infant Neurological Examination score was of 21.0 (range 9-75). There was a correlation between birth head circumference with the cognitive (r = 0.3, P < .01), language (r = 0.3, P < .01), and motor (r = 0.3, P < .01) Bayley-III Scales of Infant and Toddler Development Test scores, as well as with the Hammersmith Infant Neurological Examination score (r = 0.2, P < .03). An association was observed between an inferior median Hammersmith Infant Neurological Examination score with congenital microcephaly (P = .04), arthrogryposis (P = .02), and epilepsy in the first year (P < .01). Conclusion: Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow-up. Birth head circumference, arthrogryposis, and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents' guiding, and future prognostic studies.