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Neurodevelopment of 24 children born in Brazil with congenital Zika syndrome in 2015: a case series study
  1. Lucas V Alves1,
  2. Camila E Paredes2,
  3. Germanna C Silva2,
  4. Júlia G Mello3,
  5. João G Alves3
  1. 1 Department of Paediatrics Neurology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  2. 2 Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
  3. 3 Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  1. Correspondence to Dr João G Alves; joaoguilherme{at}


Objective To describe the neurodevelopment of children with congenital Zika syndrome during the second year of life.

Design Case series study.

Setting Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Pernambuco, Brazil.

Participants 24 children with congenital Zika syndrome born with microcephaly during the Zika outbreak in Brazil in 2015 and followed up at the IMIP during their second year of life.

Main outcome measure Denver Developmental Screening Test II, head circumference and clinical neurological examination.

Results All children presented neurodevelopmental delay: for an average chronological age of 19.9 months, language was equivalent to that of age 2.1 months, gross motor 2.7 months, fine motor/adaptive 3.1 months and personal/social 3.4 months. Head circumference remained below the third percentile for age and gender, and growth rate up to the second year of life was 10.3 cm (expected growth 13 cm). Muscle tone was increased in 23 (95.5%) of 24 children, musculotendinous reflexes were increased in the whole sample and clonus was present in 18 (77.3%) of 24 children. All children except one had epilepsy.

Conclusion Children born with microcephaly associated with congenital Zika virus have a significant neurodevelopmental delay.

  • paediatric neurology

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  • Contributors LVA and JGM contributed to conception of the work. LVA, CEP and GCS contributed to the acquisition of data. LVA, JGM and JGA contributed to the analysis and interpretation of data for the work. LVA is the guarantor. LVA, CEP, GCS, JGM and JGA drafted the work and revised it critically. LVA, CEP, GCS, JGM and JGA approved the version to be published.

  • Funding This research was supported by Bill & Melinda Gates Foundation and CNPq grant 439986/2016-8.

  • Disclaimer The lead author (LVA) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval This study was approved by the IMIP Research Ethical Committee (CAAE 6167876.1.0000.5201).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Clinical data are available from the corresponding author at

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