{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:27:48Z","timestamp":1784698068448,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The Zika virus outbreak, which occurred from 2015 to 2016 in Brazil, resulted in the birth of neonates with brain malformations arising from Congenital Zika Syndrome (CZS). The characterization of primitive reflexes and their relationships with other motor characteristics, easily clinically detectable by health professionals, can aid in establishing motor prognosis in affected children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe reflex patterns in children with Cerebral Palsy (CP) due to CZS, and investigate associations with other motor features. Method: Observational cross-sectional study involving infants with CZS aged between 12 and 36 months. Primitive reflexes, protective reaction and markers of motor phenotype were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>48 children, median age: 19 months, were enrolled, most (79.2%) presented very severe CP (GMFCS 5), the persistence of more than 5 primitive reflexes (55%) and motor development age between 3 and 6 months (33.3%) (Bayley-III). A reduced ability to acquire motor skills was associated with the total number of persistent reflexes (rho\u2009=\u2009\u22120.45, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01). Asymmetrical Tonic Neck Reflex (ATNR) correlated with GMFCS level (rho\u2009=\u20090.49, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Lower motor development age was linked to abnormal posturing (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and absence of Parachute Reaction (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Infants with CP due to CZS present severe motor abnormalities. Lower motor development age is associated with the persistence of more than 5 primitive reflexes, abnormal posturing and the absence of Parachute Reaction. Parachute Reaction appears to be a prognostic marker of motor impairment severity in CZS-affected infants.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1483959","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T06:48:03Z","timestamp":1741330083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Primitive reflexes in infants with cerebral palsy due to Congenital Zika Syndrome and its relationship with other motor features"],"prefix":"10.3389","volume":"13","author":[{"given":"Leticia","family":"Serra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9bora Patr\u00edcia","family":"Rios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mino","family":"Rios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breno Lima","family":"de Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly de Souza","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Lucena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isadora Cristina","family":"de Siqueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/S0140-6736(15)61273-9","article-title":"Zika Virus: following the path of dengue and chikungunya?","volume":"386","author":"Musso","year":"2015","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1590\/0074-02760150192","article-title":"First report of autochthonous transmission of Zika virus in Brazil","volume":"110","author":"Zanluca","year":"2015","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"B3","article-title":"Situa\u00e7\u00e3o epidemiol\u00f3gica da s\u00edndrome cong\u00eanita associada \u00e0 infec\u00e7\u00e3o pelo v\u00edrus Zika em 2020, at\u00e9 a SE 45. Volume 51 | No 47","year":"2020"},{"key":"B4","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.ijid.2021.10.051","article-title":"Detection and sequencing of Zika virus in normocephalic newborns with congenital Zika infection","volume":"114","author":"de Almeida","year":"2022","journal-title":"Int J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/jamapediatrics.2016.3982","article-title":"Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians","volume":"171","author":"Moore","year":"2017","journal-title":"JAMA Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1002\/ajmg.a.38170","article-title":"The phenotypic spectrum of congenital Zika syndrome","volume":"173","author":"Del Campo","year":"2017","journal-title":"Am J Med Genet A"},{"key":"B7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1177\/0883073818811234","article-title":"Children born with congenital Zika syndrome display atypical gross motor development and a higher risk for cerebral palsy","volume":"34","author":"Marques","year":"2019","journal-title":"J Child Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1016\/j.braindev.2020.06.016","article-title":"Movement disorders in children with congenital Zika virus syndrome","volume":"42","author":"van der Linden","year":"2020","journal-title":"Brain Dev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.3201\/eid2211.160956","article-title":"Early growth and neurologic outcomes of infants with probable congenital Zika virus syndrome","volume":"22","author":"da Silva","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S167","DOI":"10.1542\/peds.2017-2038F","article-title":"Motor abnormalities and epilepsy in infants and children with evidence of congenital Zika virus infection","volume":"141","author":"Pessoa","year":"2018","journal-title":"Pediatrics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2321","DOI":"10.1056\/NEJMoa1602412","article-title":"Zika virus infection in pregnant women in Rio de Janeiro","volume":"375","author":"Brasil","year":"2016","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/S0140-6736(16)30902-3","article-title":"Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation","volume":"388","author":"Fran\u00e7a","year":"2016","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st project","volume":"384","author":"Villar","year":"2014","journal-title":"Lancet"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.3390\/jcm8101616","article-title":"Cerebral palsy: early markers of clinical phenotype and functional outcome","volume":"8","author":"Einspieler","year":"2019","journal-title":"J Clin Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.11606\/issn.1679-9836.v82i1-4p22-33","article-title":"Proped\u00eautica neurol\u00f3gica do rec\u00e9m-nascido e sua evolu\u00e7\u00e3o","volume":"82","author":"Gherpelli","year":"2003","journal-title":"Rev Med"},{"key":"B16","unstructured":"Ara\u00fajo\n              MGM\n            \n          \n          Campinas\n          SP\n          Campinas State University\n          Avalia\u00e7\u00e3o cl\u00ednico-neurol\u00f3gica de rec\u00e9m-nascidos subnutridos e normais a termo: acompanhamento do desenvolvimento no primeiro ano de vida e detec\u00e7\u00e3o de altera\u00e7\u00f5es\n          \n          1998"},{"key":"B17","volume-title":"Bayley Scales of Infant and Toddler Development","author":"Bayley","year":"2006"},{"key":"B18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1590\/1982-43272664201606","article-title":"BayleyIII scales of infant and toddler development: transcultural adaptation and psychometric properties","volume":"26","author":"Madaschi","year":"2016","journal-title":"Paid (Ribeir\u00e3o Preto)"},{"key":"B19","article-title":"GMFCS\u2014E&R: Sistema de classifica\u00e7\u00e3o da fun\u00e7\u00e3o motora grossa- ampliado e revisto. [S.l: s.n.]","author":"Silva","year":"2010"},{"key":"B20","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1111\/dmcn.12876","article-title":"Use of the hammersmith infant neurological examination in infants with cerebral palsy: a critical review of the literature","volume":"58","author":"Romeo","year":"2016","journal-title":"Dev Med Child Neurol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1111\/j.1469-8749.2007.tb12610.x","article-title":"A report: the definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev Med Child Neurol"},{"key":"B22","volume-title":"Texto e Atlas do Desenvolvimento Motor Normal e Seus Desvios no Lactente: Diagn\u00f3stico e Tratamento Precoce do Nascimento at\u00e9 18 m\u00eas","author":"Flehmig","year":"2002"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.3390\/ijerph15091990","article-title":"Growth and development of children with microcephaly associated with congenital Zika virus syndrome in Brazil","volume":"125","author":"Fran\u00e7a","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"B24","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/S1473-3099(17)30727-2","article-title":"Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study [published correction appears in Lancet Infect Dis. 2018 Feb;18(2):139. doi: 10.1016\/S1473-3099(18)30001-X]","volume":"18","author":"de Ara\u00fajo","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/S2352-4642(20)30041-9","article-title":"Neurological outcomes of congenital Zika syndrome in toddlers and preschoolers: a case series","volume":"4","author":"Pereira","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/DBP.0000000000000722","article-title":"Early gross motor development among Brazilian children with microcephaly born right after Zika virus infection outbreak","volume":"41","author":"Ventura","year":"2020","journal-title":"J Dev Behav Pediatr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1177\/0883073819885724","article-title":"Cerebral palsy in children with congenital Zika syndrome: a 2-year neurodevelopmental follow-up","volume":"35","author":"Carvalho","year":"2020","journal-title":"J Child Neurol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1080\/17518423.2021.1960917","article-title":"Botulinum toxin type A in the spasticity of cerebral palsy related to congenital Zika syndrome: an observational study","volume":"25","author":"Armani-Franceschi","year":"2022","journal-title":"Dev Neurorehabil"},{"key":"B29","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3390\/toxins13020137","article-title":"Botulinum neurotoxin injections in childhood opisthotonus","volume":"13","author":"Hull","year":"2021","journal-title":"Toxins (Basel)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/dmcn.13051","article-title":"Prognostic significance of neurological signs in high-risk infants\u2014a systematic review","volume":"58","author":"Hamer","year":"2016","journal-title":"Dev Med Child Neurol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1590\/0004-282X20200020","article-title":"Clinical characteristics of children with congenital Zika syndrome: a case series","volume":"78","author":"Massetti","year":"2020","journal-title":"Arq Neuropsiquiatr"},{"key":"B32","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1111\/dmcn.14227","article-title":"Motor function in children with congenital Zika syndrome","volume":"62","author":"Melo","year":"2020","journal-title":"Dev Med Child Neurol"},{"key":"B33","article-title":"Zika epidemiology update\u2014May 2024","year":"2024"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1483959\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T06:48:08Z","timestamp":1741330088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1483959\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,7]]},"references-count":33,"alternative-id":["10.3389\/fped.2025.1483959"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1483959","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,7]]},"article-number":"1483959"}}