Motor development of children exposed to the zika virus: systematic reviews

Abstract Objectives: to describe the motor development, in the first two years of life, of children with evidence of congenital Zika virus syndrome (CZS) at birth and of children exposed to the Zika virus (ZIKV) during pregnancy, but without evidence of CZS. Methods: systematic review, according to the recommendations of the Preferred Reporting Items for Systematic Reviews (PRISMA). The search took place in the VHL/LILACS interface and BIREME/ PubMed interface databases until March 2020. Two researchers analyzed the quality of the studies using the Johanna Briggs Institute methodology. Results: 21 articles were selected. Children with CZS have severe impairment of motor functions and a high prevalence of spastic cerebral palsy. At two years of life, most reached only early levels of motor development; with impaired vision, hearing, language, cognition, behavior, and social interaction. On the other hand, children exposed to ZIKV, but without evidence of CZS, are at lower risk, about 20% have late manifestations of delay and/or neurodevelopmental disorder. Variables associated with greater motor impairment are early maternal infection, preterm birth, lower head circumference, abnormal imaging, use of anticonvulsant, increasing age, arthrogryposis, epilepsy, deficits in vision, language, cognition, and lower income. Conclusion: Most children with CZS show severe motor impairment; a small part of those exposed to ZIKV, without evidence of the syndrome at birth, have alteration in neurodevelopment. Those children should be followed in the long-term, since some manifestations may occur belatedly.摘要 研究目的：描述出生时确诊先天性寨卡病毒综合征（congenital Zika virus syndrome, CZS）的儿童，以及妊娠期间暴露于寨卡病毒（Zika virus, ZIKV）但无CZS证据的儿童，在生命最初两年的运动发育情况。研究方法：本研究为系统评价，严格遵循《系统评价首选报告条目》（Preferred Reporting Items for Systematic Reviews, PRISMA）的推荐规范。检索工作截至2020年3月，检索数据库涵盖VHL/LILACS平台与BIREME/ PubMed数据库。由2名研究者采用约翰娜·布里格斯研究所（Johanna Briggs Institute）方法学对纳入研究的质量进行评估。研究结果：最终纳入21篇文献。确诊CZS的儿童存在严重运动功能损害，痉挛型脑性瘫痪患病率极高。在2岁时，多数儿童仅达到早期运动发育水平，同时伴随视觉、听觉、语言、认知、行为及社会交互功能受损。相较而言，妊娠期间暴露于ZIKV但无CZS证据的儿童风险更低，仅约20%会出现发育迟滞和（或）神经发育障碍的迟发性表现。与运动损害程度加重相关的变量包括：母体早期感染、早产、头围偏小、影像学检查异常、使用抗惊厥药物、年龄增长、关节弯曲症、癫痫、视觉与语言认知缺陷，以及低收入水平。研究结论：多数CZS患儿存在严重运动功能损害；少数出生时无CZS证据的ZIKV暴露儿童会出现神经发育异常。此类儿童需接受长期随访，因为部分神经发育异常表现可能迟发出现。