[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Cardiac findings in infants with in utero exposure to Zika virus- a cross sectional study
Dulce H. G. Orofino , Sonia R. L. Passos , Raquel V. C. de Oliveira , Carla Verona B. de Farias , Maria de Fatima M. P. Leite , Sheila M. Pone , Marcos V. da S. Pone , Helena A. R. Teixeira Mendes , Maria Elizabeth L. Moreira , Karin Nielsen-Saines
Published: March 26, 2018 / DOI: https://doi.org/10.1371/journal.pntd.0006362 / This is an uncorrected proof.
Antenatal exposure to Zika virus (ZIKV) is related to severe neurological manifestations. A previous study in Brazil reported an increased incidence of non-severe congenital heart defects in infants with diagnosis of congenital Zika syndrome but without laboratory confirmation of ZIKV infection in the mother or infant. The objective of this study is to report echocardiographic (ECHO) findings in infants with laboratory confirmed antenatal exposure to ZIKV.
Cross sectional study of cardiologic assessments of infants born between November 2015 and January 2017 with confirmed vertical exposure to ZIKV in Rio de Janeiro, Brazil.
The study enrolled 120 children with a median age of 97 days (1 to 376 days). In utero exposure to ZIKV was confirmed in 97 children (80,8%) through positive maternal polymerase chain reaction (PCR) results during pregnancy or a positive PCR result at birth; 23 additional children (19.2%) had maternal positive PCR results during pregnancy and postnatally. Forty- eight infants (40%) had cardiac defects noted on ECHO. Thirteen infants (10.8%) had major cardiac defects (atrial septal defect, ventricular septal defect, patent ductus arteriosus). None of the defects were severe. The frequency of major defects was higher in infants whose mothers had a rash in the 2nd trimester of pregnancy, or who had altered Central Nervous System (CNS) imaging postnatally or were preterm.
Infants with in utero ZIKV exposure have a higher prevalence of major cardiac defects, however none were severe enough to require immediate intervention. For this reason, guidelines for performance of postnatal ECHO in this population should follow general newborn screening guidelines, which significantly reduces the burden of performing emergent fetal or neonatal ECHOs in a setting where resources are not available, such as most Brazilian municipalities.
We performed cardiologic assessment of 120 infants born between November 2015 and January 2017 with confirmed vertical exposure to Zika virus (ZIKV). The diagnosis of ZIKV exposure was confirmed by PCR in maternal blood specimens and/or amniotic fluid during pregnancy and/or infant specimens including PCR of the cerebrospinal fluid (CSF) and/or urine following birth. Our study found a 10.8% incidence of structural heart defects in infants with a history of intrauterine exposure to ZIKV, a rate considerably higher than that observed in the general population. However, no patients were found to have severe structural heart defects. The presence of major defects was increased in infants whose mothers had a history of rash in the 2nd trimester, infants with altered CNS imaging and/or preterm infants. As severe heart defects requiring immediate intervention were not identified, guidelines for performance of postnatal ECHO in this population should follow the same criteria as the ones applicable to newborns in general, particularly since resources for performance of fetal and neonatal echocardiograms are not routinely available in most Brazilian municipalities
Citation: Orofino DHG, Passos SRL, de Oliveira RVC, de Farias CVB, Leite MdFMP, Pone SM, et al. (2018) Cardiac findings in infants with in utero exposure to Zika virus- a cross sectional study. PLoS Negl Trop Dis 12(3): e0006362. https://doi.org/10.1371/journal.pntd.0006362
Editor: Walderez O. Dutra, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, BRAZIL
Received: October 6, 2017; Accepted: March 4, 2018; Published: March 26, 2018
Copyright: © 2018 Orofino et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files
Funding: Sonia Regina Lambert Passos was supported by MCTI | Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Grants 440846/2016-1 and 310765/2016-1; supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Grant 88881130793/2016-01 and by Universidade Estácio de Sá-Bolsa Produtividade. Helena Alencar Rosa Teixeira Mendes was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Grant 88887130789/2016-00. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Zika Virus; Zika Congenital Infection; Cardiology.