Zika-Related Microcephaly in the First 5 Years After Birth

OBJECTIVE: To characterize clinical manifestations and complications of children with Zika-related microcephaly in the first 5 years after birth. METHODS: A cohort of children with Zika-related microcephaly were observed up to age 60 months as part of the Microcephaly Epidemic Research Group Pediatric Cohort. RESULTS: Among the 181 children, 43.1% were male and 77.2% were born at term. The median birth weight was 2700 g, with 64.8% classified as small for gestational age. Notably, 22.3% were diagnosed with microcephaly after birth, and 48.8% had severe microcephaly. Most common phenotypic characteristics were craniofacial disproportion (54.1%), arthrogryposis (35.9%), and exacerbated occipital protuberance (35.5%). Approximately one-third (33.1%) presented with dysphagia (n = 151 evaluated at median age of 28.2 months), and 13.3% of children had gastrostomies (median age of 24 months). Hearing anomalies were detected in 9.7% (n = 93 evaluated at median age of 30 months). In ophthalmological evaluation, 30.4% showed changes in the retina and 28.5% in the optic nerve; strabismus was observed in 53.4%. During neurological assessment (median age at first assessment of 15.9 months), 73.8% presented with abnormalities. Imaging examinations showed ventriculomegaly and cortical atrophy in 75.3% and 64.4% of the children, respectively. Electroencephalography was performed based on clinical indication in 84 children, of whom 92.9% had pattern alterations. Over the 5 years, 62.4% were hospitalized, mainly for respiratory problems and seizures. CONCLUSIONS: The study highlights the severity of Zika-related microcephaly. Future research should prioritize continued systematic monitoring of these children to understand the frequency and timing of late-onset manifestations and complications, including death.