Análise das repercussões clínicas em neonatos expostos ao vírus zika durante a gestação: um estudo retrospectivo em Belo Horizonte, Brasil

Abstract

Introduction: The zika vírus (ZIKV) is a Flavivirus that belongs to the Flaviviridae family. The virus became pandemic and transmission was first detected in the Americas in 2015. In Brasil, initial detection occurred in the Northeast Region and it was found in Belo Horizonte in November 2015. The association between ZIKV infection and teratogenicity in exposed concepts is well established. In addition to microcephaly, congenital infection may lead to other morphological changes, referred to a congenital zika syndrome (CZS). Justification: It is important to elucidate the real impact to fetal development and newborns of the exposure to ZIKV during pregnancy. Objective: To evaluate the clinical outcome of ZIKV exposure during pregnancy of newborns assisted by the Public Health System of Belo Horizonte. Methodology: This is a retrospective cohort study of pregnant women residing in Belo Horizonte, in Minas Gerais state, Brazil, who were diagnosed with ZIKV infection during 2016 to 2018 and were monitored by the municipal network of the Unified Health System (SUS). From identification data of pregnant women with confirmed ZIKV infection, outcome of pregnancy and clinical details of new born were obtained from the electronic medical record (SISREDE) of the Belo Horizonte City Hall. Results and discussion: The overall incidence of congenital abnormalities was 13% in newborns whose mothers had ZIKV during the pregnancy. The alterations related to CZS were 8% and 4% had microcephaly. Of these, the others congenital infections were ruled out in 78% of cases of the microcephaly and other congenital abnormalities characteristic of CZS were more frequent in babies whose mothers became infected in the first trimester of pregnancy. However, there were also abnormalities in babies exposed to ZIKV in the second and third trimesters, demonstrating an important teratogenic and neurotropic role of ZIKV. The main phenotypic abnormalities detected in microcephalic children exposed to ZIKV were cerebral repercussions (calcifications, cortical changes and atrophy brain). The changes detected in neonatal screening exams (ultrasound via the fontanelle (56%), fundoscopy (33%) and hearing evaluations (29%)) were frequent in children with microcephaly. Others alterations, such as heart malformations, were also present in most children with microcephaly. Microcephalic babies had an apparent increase of complication during labor and tendency to manifest prematurity at birth. there did not appear to be changes in the trend patterns of type of delivery and APGAR index. Conclusion: Our study in Belo Horizonte show that Zika infection during pregnancy has significant impact on the fetus with potential impact on child development and the need for specific and multidisciplinary treatment.