Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life

Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from -0.45 +/- 0.1 to 0.27 +/- 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus -1.84 +/- 0.2 to -2.15 +/- 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from -0.3 +/- 0.1 at 1 month to 0.17 +/- 0.2 SD between 31 and 36 months in the NCZS group, versus -2.3 +/- 0.3 to -2.0 +/- 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 +/- 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 +/- 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.