{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:00:51Z","timestamp":1791284451493,"version":"4.1.0"},"reference-count":57,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"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>Background: The Zika virus outbreak has affected pregnant women and their infants. Affected infants develop microcephaly and other congenital malformations referred to as congenital Zika syndrome. The neurological manifestations of congenital Zika syndrome may result in some feeding disorders, including dysphagia, swallowing dysfunction and choking while feeding. The aim of this study was to assess the prevalence of feeding and breastfeeding difficulties in children with congenital Zika syndrome and to estimate the risk of developing feeding disabilities. Methods: We searched PubMed, Google Scholar and Scopus for studies published from 2017 to 2021. From the total of 360 papers, reviews, systematic reviews, meta-analyses and publications in languages other than English were excluded. Therefore, the final sample of our study consisted of 11 articles about the feeding\/breastfeeding difficulties of infants and children with congenital Zika syndrome. Results: Infants and children with congenital Zika syndrome were likely to suffer from feeding difficulties at various levels, including breastfeeding. Dysphagia problems ranged from 17.9% to 70%, and nutritional and non-nutritive suckling of infants was also affected. Conclusions: In addition to continuing to investigate the neurodevelopment of affected children, future research should also focus on the severity of factors influencing the degree of dysphagia, as well as the impact of breastfeeding on the child\u2019s overall development.<\/jats:p>","DOI":"10.3390\/v15030601","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T04:33:56Z","timestamp":1677040436000},"page":"601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Congenital Zika Syndrome and Disabilities of Feeding and Breastfeeding in Early Childhood: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4494-3089","authenticated-orcid":false,"given":"Evangelia","family":"Antoniou","sequence":"first","affiliation":[{"name":"Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi Eva","family":"Andronikidi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Crete, 71003 Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Eskitzis","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-040X","authenticated-orcid":false,"given":"Maria","family":"Iliadou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermioni","family":"Palaska","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6051-0860","authenticated-orcid":false,"given":"Maria","family":"Tzitiridou-Chatzopoulou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Rigas","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7458-7500","authenticated-orcid":false,"given":"Eirini","family":"Orovou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece"},{"name":"Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"ref_2","unstructured":"(2022, October 14). Assesssment and Management of Guillain-Barr\u00e9 Syndrome in the Context of Zika Virus Infection: Interim Guidance Update. Available online: https:\/\/www.who.int\/publications-detail-redirect\/WHO-ZIKV-MOC-16.4-Rev.1."},{"key":"ref_3","unstructured":"CDC (2020, February 13). Zika Outcomes Investigation (ZODIAC)|CDC. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/pregnancy\/zika\/research\/zodiac.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19198","DOI":"10.1038\/s41598-019-55598-6","article-title":"Zika Virus Infection in Pregnancy and Infant Growth, Body Composition in the First Three Months of Life: A Cohort Study","volume":"9","author":"Soares","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"116","DOI":"10.3855\/jidc.8217","article-title":"Zika Virus Outbreak in Brazil","volume":"10","author":"Heukelbach","year":"2016","journal-title":"J. Infect. Dev. Ctries"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"WHO (2016). Defining the syndrome associated with congenital Zika virus infection. Bull. World Health Organ., 94, 406.","DOI":"10.2471\/BLT.16.176990"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S891","DOI":"10.1093\/infdis\/jix448","article-title":"Zika Virus Infection in Pregnancy: Maternal, Fetal, and Neonatal Considerations","volume":"216","author":"Zorrilla","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gullo, G., Scaglione, M., Cucinella, G., Riva, A., Coldebella, D., Cavaliere, A.F., Signore, F., Buzzaccarini, G., Spagnol, G., and Lagan\u00e0, A.S. (2022). Congenital Zika Syndrome: Genetic Avenues for Diagnosis and Therapy, Possible Management and Long-Term Outcomes. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051351"},{"key":"ref_9","unstructured":"CDC (2020, October 29). Congenital Zika Syndrome & Other Birth Defects|CDC. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/pregnancy\/zika\/testing-follow-up\/zika-syndrome-birth-defects.html."},{"key":"ref_10","doi-asserted-by":"crossref","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":"ref_11","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/ajmg.a.38170","article-title":"The Phenotypic Spectrum of Congenital Zika Syndrome","volume":"173","author":"Feitosa","year":"2017","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/S1473-3099(17)30398-5","article-title":"Infectious Causes of Microcephaly: Epidemiology, Pathogenesis, Diagnosis, and Management","volume":"18","author":"Devakumar","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S1473-3099(17)30710-7","article-title":"Zika Epidemic: A Step towards Understanding the Infectious Causes of Microcephaly?","volume":"18","author":"Ramos","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","unstructured":"(2020, February 14). Birth Defects|Zika virus|CDC, Available online: https:\/\/www.cdc.gov\/zika\/healtheffects\/birth_defects.html."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1056\/NEJMoa1601824","article-title":"Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities","volume":"374","author":"Driggers","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3389\/fimmu.2020.00175","article-title":"Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes","volume":"11","author":"Teixeira","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6472","DOI":"10.1016\/j.vaccine.2017.01.044","article-title":"Congenital Microcephaly: Case Definition & Guidelines for Data Collection, Analysis, and Presentation of Safety Data after Maternal Immunisation","volume":"35 Pt A","author":"DeSilva","year":"2017","journal-title":"Vaccine"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Pe\u00e7anha, P.M., Gomes Junior, S.C., Pone, S.M., Pone, M.V.d.S., Vasconcelos, Z., Zin, A., Vilibor, R.H.H., Costa, R.P., Meio, M.D.B.B., and Nielsen-Saines, K. (2020). Neurodevelopment of Children Exposed Intra-Uterus by Zika Virus: A Case Series. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229434"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Jones, B. (2003). Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy, Springer Science & Business Media.","DOI":"10.1007\/978-0-387-22434-3"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/BF02493469","article-title":"Coordination of Mastication and Swallowing","volume":"7","author":"Palmer","year":"1992","journal-title":"Dysphagia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.pmr.2008.06.001","article-title":"Anatomy and Physiology of Feeding and Swallowing\u2013Normal and Abnormal","volume":"19","author":"Matsuo","year":"2008","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_22","first-page":"1219","article-title":"Effects of Swallowing on the Pattern of Continuous Respiration in Human Adults","volume":"132","author":"Nishino","year":"1985","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/BF00301912","article-title":"Epidemiology and Dysphagia","volume":"9","author":"Kuhlemeier","year":"1994","journal-title":"Dysphagia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1136\/pmj.77.913.694","article-title":"Management of Neurogenic Dysphagia","volume":"77","author":"Bakheit","year":"2001","journal-title":"Postgrad. Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.3201\/eid2308.170354","article-title":"Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015","volume":"23","author":"Leal","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","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":"Ganz","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","unstructured":"World Health Organization (2022, October 15). Screening, Assessment and Management of Neonates and Infants with Complications Associated with Zika Virus Exposure in Utero: Rapid Advice Guideline, Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/204475."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.15585\/mmwr.mm6547e2","article-title":"Description of 13 Infants Born During October 2015\u2013January 2016 with Congenital Zika Virus Infection Without Microcephaly at Birth\u2014Brazil","volume":"65","year":"2016","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12937-019-0429-3","article-title":"Infants with Microcephaly Due to ZIKA Virus Exposure: Nutritional Status and Food Practices","volume":"18","author":"Soares","year":"2019","journal-title":"Nutr. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1542\/peds.2008-3256","article-title":"Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy","volume":"126","author":"Duijts","year":"2010","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/jech-2013-202500","article-title":"Breastfeeding Duration and Cognitive, Language and Motor Development at 18\u2005Months of Age: Rhea Mother-Child Cohort in Crete, Greece","volume":"69","author":"Leventakou","year":"2015","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e6452","DOI":"10.7717\/peerj.6452","article-title":"Breastfeeding in the Time of Zika: A Systematic Literature Review","volume":"7","author":"Sampieri","year":"2019","journal-title":"PeerJ"},{"key":"ref_33","unstructured":"World Health Organization (2016). Infant Feeding in Areas of Zika Virus Transmission."},{"key":"ref_34","unstructured":"(2023, January 15). Developmental Stages in Infant and Toddler Feeding. Infant & Toddler Forum. Available online: https:\/\/infantandtoddlerforum.org\/toddlers-to-preschool\/growth-and-development-of-toddlers\/developmental-stages\/."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_36","unstructured":"(2022, October 08). Study Quality Assessment Tools|NHLBI, NIH, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.15585\/mmwr.mm6649a2","article-title":"Health and Development at Age 19-24 Months of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital Zika Virus Infection During the 2015 Zika Virus Outbreak-Brazil, 2017","volume":"66","author":"Kotzky","year":"2017","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ferreira, H.N.C., Schiariti, V., Regalado, I.C.R., Sousa, K.G., Pereira, S.A., Fechine, C.P.N.D.S., and Longo, E. (2018). Functioning and Disability Profile of Children with Microcephaly Associated with Congenital Zika Virus Infection. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15061107"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e798","DOI":"10.6061\/clinics\/2019\/e798","article-title":"Nutritional Profile of Newborns with Microcephaly and Factors Associated with Worse Outcomes","volume":"74","author":"Soares","year":"2019","journal-title":"Clinics"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"de Carvalho-Sauer, R.d.C.O., Costa, M.d.C.N., Paix\u00e3o, E.S., de Jesus Silva, N., Barreto, F.R., and Teixeira, M.G. (2020). Cross-Sectional Study of the Anthropometric Characteristics of Children with Congenital Zika Syndrome up to 12\u2009Months of Life. BMC Pediatrics, 20.","DOI":"10.1186\/s12887-020-02365-6"},{"key":"ref_41","first-page":"e1078250","article-title":"Breastfeeding Behavior in Brazilian Children with Congenital Zika Syndrome","volume":"2020","author":"Aguiar","year":"2020","journal-title":"Int. J. Dent."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.oooo.2020.02.019","article-title":"Oral and Maxillofacial Conditions, Dietary Aspects, and Nutritional Status of Children with Congenital Zika Syndrome","volume":"130","author":"Mendes","year":"2020","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Medeiros, A.M.C., Jardim-Botelho, A., Santos, E.M.d.S., Lopes, A.d.S.A., Santos, F.B., de S\u00e1, T.P.L., Barreto, \u00cd.D.C., dos Santos, C.A., Cuevas, L.E., and Gurgel, R.Q. (2021). Feeding Methods and Weight Evolution in Newborns with Congenital Microcephaly Due for Zika Virus. Audiol. Commun. Res., 26.","DOI":"10.1590\/2317-6431-2020-2395"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lowe, R., Barcellos, C., Brasil, P., Cruz, O.G., Hon\u00f3rio, N.A., Kuper, H., and Carvalho, M.S. (2018). The Zika Virus Epidemic in Brazil: From Discovery to Future Implications. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15010096"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1016\/S0140-6736(16)00651-6","article-title":"Association between Zika Virus and Microcephaly in French Polynesia, 2013\u20132015: A Retrospective Study","volume":"387","author":"Cauchemez","year":"2016","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jped.2018.10.016","article-title":"Effects of Zika Infection on Growth","volume":"95","author":"Martins","year":"2019","journal-title":"J. De Pediatr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e001095","DOI":"10.1136\/bmjpo-2021-001095","article-title":"Children with Neurodisability and Feeding Difficulties: A UK Survey of Parent-Delivered Interventions","volume":"5","author":"Taylor","year":"2021","journal-title":"BMJ Paediatr. Open"},{"key":"ref_48","unstructured":"(2022, December 16). CanChild. Available online: https:\/\/www.canchild.ca\/en\/resources\/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r."},{"key":"ref_49","unstructured":"Modrell, A.K., and Tadi, P. (2022). StatPearls, StatPearls Publishing."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1080\/00325481.2021.1941142","article-title":"Dietary Management of Infants and Young Children with Feeding Difficulties and Unsatisfactory Weight Gain Using a Nutritionally Complete Hypercaloric Infant Formula. Practical Considerations from Clinical Cases","volume":"133","author":"Matuszczyk","year":"2021","journal-title":"Postgrad. Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Carroll, C., Booth, A., Campbell, F., and Relton, C. (2020). What Are the Implications of Zika Virus for Infant Feeding? A Synthesis of Qualitative Evidence Concerning Congenital Zika Syndrome (CZS) and Comparable Conditions. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008731"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"4144","DOI":"10.4034\/PBOCI.2018.181.69","article-title":"Born in Chains: Perceptions of Brazilian Mothers Deprived of Freedom about Breastfeeding","volume":"18","author":"Cavalcanti","year":"2018","journal-title":"Pesqui. Bras. Odontopediatria Cl\u00edn. Integr"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.jped.2017.10.005","article-title":"Association between Pacifier Use and Bottle-Feeding and Unfavorable Behaviors during Breastfeeding","volume":"94","author":"Batista","year":"2018","journal-title":"J. De Pediatr."},{"key":"ref_54","unstructured":"WHO (2022, December 16). Statement on the 2nd Meeting of IHR Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations, Available online: https:\/\/www.who.int\/news\/item\/08-03-2016-who-statement-on-the-2nd-meeting-of-ihr-emergency-committee-on-zika-virus-and-observed-increase-in-neurological-disorders-and-neonatal-malformations."},{"key":"ref_55","unstructured":"World Health Organization. Division of Diarrhoeal and Acute Respiratory Disease Control, and Fund (UNICEF), U.N.C (2022, December 16). Breastfeeding Counselling: A Training Course, Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/63428."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/0890334412444005","article-title":"Breastfeeding and Neonatal Weight Loss in Healthy Term Infants","volume":"29","author":"Davanzo","year":"2013","journal-title":"J. Hum. Lancet"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1089\/bfm.2017.0122","article-title":"The Science of Breastfeeding and Brain Development","volume":"12","author":"Belfort","year":"2017","journal-title":"Breastfeed Med."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/601\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:39:09Z","timestamp":1760121549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":57,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["v15030601"],"URL":"https:\/\/doi.org\/10.3390\/v15030601","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}