Congenital neural tube defects evaluation in newborns with prenatal Zika virus infection

Abstract

Introduction: Neural Tube Defects (NTD) occurrence depends of genetic or environmental causes, as ilicit or medical drug use, vitamin insuficiency or gestational infections. Acquired microcephaly is presumed to result from brain injury, like hypoxicischemic injury, intracranial infection or metabolic disease. Both occur in different embryogenesis steps, share similar etiologic factors, sometimes not explained. Methods: Our prospective series evaluated all newborns up to 5 days of life with or without microcephaly in the high risk Maternity from Sergipe-Brazil, between 01 November and 31 December 2015. Gestational dates about Zika virus mother infection, respiratory tract infections, exanthematic diseases, TORCH assays, ilicit or medical drug use, folic acid supplementation were collected. The children were examined in the search of skin stigmata underlying NTD (dimples, deviated gluteal fold, subcutaneous lipomas, hypertrichosis, hemangiomas and nevus) and other associated systemic malformations. Results: There were examined 33 newborns (10M/20F; gestational age 38,06+/-1,2 weeks [35-41]) with microcephaly (head circumference 30,34+/-2,67cm [21-33]) and Zika virus gestational infection associated (13 cases confirmed mother history of clinical or subclinical infecction and 33 negative TORCH assays). No cases presented skin stigmata for NTD, despite brain malformations (ventriculomegaly, calcifications, dysgenesis of corpus callosum, lissencephaly). In the same time 763 newborns without microcephaly were evaluated - 16 (8M/9F) presenting skin signs suggesting NTD: dimple (1), deviated gluteal fold (13), hypertrichosis (3). Conclusions: Zika virus infection belongs to tropical diseases group transmitted by Aedes aegypti mosquito, epidemic in Brazil. First cases of Central Nervous brain congenital malformations related were registered recently. Facing this new disease and lack of knowledge about real cause, absence of skin signs suggesting NTD regardless microcephaly in these children may imply physiophatogy mechanism onset neuronal proliferation and differentiation phases, late for Neural Tube Defects.