{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:37:58Z","timestamp":1792532278594,"version":"4.5.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Congenital Zika syndrome (CZS) can lead to a range of developmental and neurological issues, which increases the risk of early death. However, the all-cause and cause-specific mortality in children with CZS in the first 5 years of life remain unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the hazard of all-cause and cause-specific mortality before age 5 years among children with and without CZS in Brazil.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used nationwide linked routine data including all children born from January 2015 to December 2018 in Brazil. They were followed-up until age 5 years, death, or December 2020, whichever occurred first. All analysis were conducted in May 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Confirmed or probable cases of CZS.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>All-cause and cause-specific deaths from respiratory, infectious and parasitic, and nervous system diseases were the outcomes. Hazard ratios (HRs), comparing children with and without CZS, for all and cause-specific mortality were estimated using Cox proportional hazard models adjusted for region and year of birth, maternal characteristics (age, education, race and\/or ethnicity, and marital status), and sex of the newborn. The analysis was conducted in May 2024.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, there were 11\u202f387\u202f431 live births (5\u202f832\u202f594 male newborns [51.2%]). Of 3080 children notified as CZS cases, 444 (14.4%) died, including 154 (34.7%) from respiratory diseases, 152 (34.2%) from infectious and parasitic diseases, and 82 (18.5%) from nervous system diseases. Children with CZS were predominantly preterm (596 newborns [20.0%] vs 1\u202f122\u202f378 newborns [10.1%]) and had low birth weight (1095 newborns [35.7%] vs 805\u202f373 newborns [7.1%]), compared with children without CZS. After controlling for confounders, children with CZS were 13.10 (95% CI,\u200911.86-14.46) times more likely to die in the first 5 years of life compared with those without the syndrome. The cause-specific mortality HRs were 30.28 (95% CI,\u200925.59-35.83) for respiratory diseases, 28.26 (95% CI,\u200923.85-33.48) for infectious and parasitic diseases, and 57.11 (95% CI,\u200945.23-72.11) for nervous system diseases. After excluding newborns who were preterm, low birth weight, and\/or small for gestational age, the HRs for all-cause and cause-specific deaths were even higher.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, children born with CZS had strikingly higher risk of overall and cause-specific mortality. These findings may support the development of clinical protocols to prevent early mortality and improve survival in these children.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.56042","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T16:32:06Z","timestamp":1737649926000},"page":"e2456042","source":"Crossref","is-referenced-by-count":8,"title":["All-Cause and Cause-Specific Mortality in Children With Congenital Zika Syndrome in Brazil"],"prefix":"10.1001","volume":"8","author":[{"given":"Luciana Lobato","family":"Cardim","sequence":"first","affiliation":[{"name":"Center of Data and Knowledge Integration for Health, Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria da Concei\u00e7\u00e3o Nascimento","family":"Costa","sequence":"additional","affiliation":[{"name":"Center of Data and Knowledge Integration for Health, Gon\u00e7alo Moniz 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