Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Micro
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ORIGINAL ARTICLE
Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly Danielle Maria da Silva Oliveira1 · Demócrito de Barros Miranda‑Filho1 · Ricardo Arraes de Alencar Ximenes1,2 · Ulisses Ramos Montarroyos1 · Celina Maria Turchi Martelli3 · Elizabeth B. Brickley4 · Mariana de Carvalho Leal Gouveia2 · Regina Coeli Ramos1 · Maria Ângela Wanderley Rocha1 · Thalia Velho Barreto de Araujo2 · Sophie Helena Eickmann2 · Laura Cunha Rodrigues4 · Jeyse Polliane de Oliveira Soares Bernardes1 · Maria Helena Teixeira Pinto1 · Karina Polo Norte Danda Soares2 · Claudia Marina Tavares de Araújo2 · Maria de Fátima Pessoa Militão‑Albuquerque3 · Ana Célia Oliveira dos Santos1 Received: 3 July 2019 / Accepted: 24 August 2020 © The Author(s) 2020
Abstract Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015–2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report. Keywords Oropharyngeal dysphagia · Zika virus · Zika-related microcephaly · Zika-exposed children without microcephaly · Congenital Zika syndrome Abbreviations ZIKV Zika virus CSA Clinical swallowing assessment PAD-PED Protocol for Assessment of Pediatric Dysphagia CZS Congenital Zika syndrome PCR Quantitative real-time polymerase chain reaction WHO World Health Organization OPD Oropharyngeal dysphagia * Danielle Maria da Silva Oliveira [email protected] Extended author information available on the last page of the article
Introduction Zika viru
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