{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:27:00Z","timestamp":1790303220681,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly. We evaluated 274 children including 235 ZIKV exposed and 39 controls using the Bayley-III Scales of Infant and Toddler Development (BSIDIII) and neurological examination. We observed a difference in cognition with a borderline p-value (p = 0.052): 9.4% of exposed children and none of the unexposed control group had mild to moderate delays. The prevalence of delays in the language and motor domains did not differ significantly between ZIKV-exposed and unexposed children (language: 12.3% versus 12.8%; motor: 4.7% versus 2.6%). Notably, neurological examination results were predictive of neurodevelopmental delays in the BSIDIII assessments for exposed children: 46.7% of children with abnormalities on clinical neurological examination presented with delay in contrast to 17.8% among exposed children without apparent neurological abnormalities (p = 0.001). Overall, our findings suggest that relative to their unexposed peers, ZIKV-exposed children without microcephaly are not at considerably increased risk of neurodevelopmental impairment in the first 42 months of life, although a small group of children demonstrated higher frequencies of cognitive delay. It is important to highlight that in the group of exposed children, an abnormal neuroclinical examination may be a predictor of developmental delay. The article contributes to practical guidance and advances our knowledge about congenital Zika.<\/jats:p>","DOI":"10.3390\/v13081427","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T22:37:14Z","timestamp":1626993434000},"page":"1427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth?"],"prefix":"10.3390","volume":"13","author":[{"given":"Paula","family":"Sobral da Silva","sequence":"first","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"},{"name":"Departamento de Neurologia Infantil, Hospital Universit\u00e1rio Oswaldo Cruz, Recife 50100-130, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6523-2107","authenticated-orcid":false,"given":"Sophie","family":"Eickmann","sequence":"additional","affiliation":[{"name":"Departamento de Pediatria, Universidade Federal de Pernambuco, Recife 50670-420, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Ximenes","sequence":"additional","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2491-0688","authenticated-orcid":false,"given":"Celina","family":"Martelli","sequence":"additional","affiliation":[{"name":"Instituto Aggeu Magalh\u00e3es\u2014Funda\u00e7\u00e3o Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0280-2288","authenticated-orcid":false,"given":"Elizabeth","family":"Brickley","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00edlia","family":"C. Lima","sequence":"additional","affiliation":[{"name":"Departamento de Pediatria, Universidade Federal de Pernambuco, Recife 50670-420, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulisses","family":"Montarroyos","sequence":"additional","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Carvalho","sequence":"additional","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"},{"name":"Departamento de Neurologia Infantil, Hospital Universit\u00e1rio Oswaldo Cruz, Recife 50100-130, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalia","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-420, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Ventura","sequence":"additional","affiliation":[{"name":"Departamento de Oftalmologia, Funda\u00e7\u00e3o Altino Ventura, Recife 52171-011, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"da Silva Oliveira","sequence":"additional","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Ferreira Ramos","sequence":"additional","affiliation":[{"name":"Departamento de Infectologia Pedi\u00e1trica, Hospital Universit\u00e1rio Oswaldo Cruz, Recife 50100-130, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dem\u00f3crito","family":"Miranda-Filho","sequence":"additional","affiliation":[{"name":"P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias da Sa\u00fade, Universidade de Pernambuco, Recife 50100-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"on behalf of the Microcephaly Epidemic Research Group (MERG)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00381-017-3634-4","article-title":"Neurological manifestations of congenital Zika virus infection","volume":"34","author":"Saad","year":"2017","journal-title":"Childs Nerv. 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