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    Original Investigation
    Infectious Diseases
    July 31, 2019

    Association Between Neonatal Neuroimaging and Clinical Outcomes in Zika-Exposed Infants From Rio de Janeiro, Brazil

    Author Affiliations
    • 1David Geffen School of Medicine, University of California, Los Angeles
    • 2Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
    • 3University of California San Francisco School of Medicine
    • 4Clinica de Diagnostico por Imagem CDPI, Rio de Janeiro, Brazil
    • 5University of Southern California School of Medicine, Los Angeles
    JAMA Netw Open. 2019;2(7):e198124. doi:10.1001/jamanetworkopen.2019.8124
    Key Points español 中文 (chinese)

    Question  Are neuroimaging findings of infants exposed to Zika virus associated with infant clinical outcomes and gestational age of antenatal Zika virus infection?

    Findings  In this cohort study of 110 infants with confirmed or suspected antenatal exposure to Zika virus evaluated at a referral center from 2015 to 2016, 96% of abnormal neuroimaging occurred among Zika virus–exposed infants with severe clinical findings at birth; however, 10% of infants without severe clinical manifestations also had neuroimaging abnormalities. In addition, an increased risk of abnormal imaging was associated with Zika virus exposure in the first trimester compared with later trimesters.

    Meaning  Neuroimaging of infants exposed to Zika virus is an important part of evaluating infants with a history of Zika virus in utero exposure, particularly for those exposed in the first trimester.


    Importance  Congenital Zika virus (ZIKV) infection may present with a spectrum of clinical and neuroradiographic findings.

    Objective  To determine whether neuroimaging findings for infants with a history of ZIKV exposure are associated with infant clinical outcomes and gestational age at antenatal ZIKV infection.

    Design, Setting, and Participants  This cohort study retrospectively reviewed neuroimaging results (computed tomography and/or magnetic resonance imaging scans) of 110 ZIKV-exposed infants from a maternity and children’s hospital in Rio de Janeiro, Brazil, following the 2015 to 2016 ZIKV epidemic. Neuroimaging from March 1, 2016, to June 30, 2017, was evaluated to determine whether findings were associated with clinical outcomes and the timing of maternal ZIKV infection. Data were analyzed from July 1, 2017, to August 30, 2018.

    Exposures  Neuroimaging (computed tomography and/or magnetic resonance imaging) was performed on ZIKV-exposed infants after birth. Blood and/or urine specimens from mothers and infants were tested for ZIKV by polymerase chain reaction assay.

    Main Outcomes and Measures  Neuroimaging studies were evaluated for structural abnormalities and other forms of brain injury.

    Results  A total of 110 infants with a mean (SD) gestational age of 38.4 (2.1) weeks had neuroimaging and clinical outcome data reviewed. Of these, 71 (65%) had abnormal neuroimaging findings, with the majority (96%) classified as having severe ZIKV infection at birth. The most common neuroimaging abnormalities were structural abnormalities including brain calcifications, especially at the cortico-subcortical white matter junction, cortex malformations, ventriculomegaly, and reduced brain volumes, followed by brainstem hypoplasia, cerebellar hypoplasia, and corpus callosum abnormalities. Frequency of abnormal imaging was higher in infants with specific clinical findings as opposed to those without them; these findings included fetal brain disruption sequence (100% vs 35%), microcephaly (100% vs 30%), congenital contractures (100% vs 58%), ophthalmologic abnormalities (95% vs 44%), hearing abnormalities (100% vs 58%), and neurologic symptoms (94% vs 10%). Four of 39 infants (10%) without initial evidence of severe ZIKV infection and normal findings on neurologic evaluation at birth had abnormal neuroimaging findings. Neuroimaging abnormalities differed by trimester of maternal ZIKV infection, with 63% of infants born to mothers infected in the first trimester, 13% of infants born to mothers infected in the second trimester, and 1% of infants born to mothers infected in the third trimester exhibiting neuroimaging abnormalities. The odds of abnormal neuroimaging were 7.9 times greater for infants with first trimester ZIKV exposure compared with other trimesters combined (odds ratio, 7.9; 95% CI, 3.0-20.4; P < .001).

    Conclusions and Relevance  Neuroimaging abnormalities of computed tomography and/or magnetic resonance imaging scans were common in ZIKV-exposed infants. While neuroimaging abnormalities were seen in 10% of infants without clinically severe ZIKV, most occurred almost exclusively among those with clinically severe ZIKV, especially among those with a history of ZIKV exposure in the first trimester.