Neurodevelopmental Outcomes in ZIKV-Exposed Children

Study Overview
=================
Brief Summary
-----------------
In this study the investigators will follow the neurodevelopmental outcome of children with in utero ZIKV exposure who do not have microcephaly or severe abnormalities consistent with Congenital Zika Syndrome. The ZIKV-exposed children will be compared to non-ZIKV exposed controls. Children will be assessed at age 3 and 4 years using standardized neurodevelopmental assessments. Children will also have neurodevelopmental assessment at age 5 and 7 years along with a brain MRI at age 7 years.

Detailed Description
-----------------
Zika-virus (ZIKV) infection in pregnancy can result in severe brain damage in 4-12% of cases. Children exposed to ZIKV in utero during the years of 2015-2017 are now in early childhood. Children with severe neurologic injury (Congenital Zika Syndrome; CZS) have a poor developmental outcome, however the developmental outcome of apparently normal infants following in utero ZIKV-exposure is not well known. The incidence of abnormal neurodevelopmental outcome in apparently normal children with in utero ZIKV-exposure is not known. The investigators will determine if neurodevelopmental assessment scores in children exposed to ZIKV in utero who are normal appearing differ from norms. The investigators hypothesize that ZIKV-exposed normal appearing children will have lower multi-domain developmental assessment scores compared to normative samples. The investigators hypothesize that the presence of mild postnatal non-specific cranial US findings is associated with persistent lower developmental assessment scores compared to ZIKV-exposed children who had normal cranial US and quantitative imaging will find structural and functional brain differences between ZIKV-exposed children and controls.. The investigators will perform a prospective developmental outcome study at 2 sites: 1) Department of Atlántico, Colombia through collaboration with BIOMELAB, the research center of Dr. Carlos Cure, and 2) Children's National, Washington, DC. The objective of the study is to determine whether children who were exposed to ZIKV in utero and who do not have CZS have abnormalities in neurodevelopment during early childhood and at school age. The primary outcome at early childhood will be neurodevelopmental assessment scores at age 3 and 4 years. Scores will be compared between Zika-exposed children and controls. The primary outcome at school age will be neurodevelopmental assessment scores at age 5 and 7 years and quantitative brain MRI at 7 years.

Official Title
-----------------
Developmental Outcome After In Utero ZIKV Exposure in Children Without Congenital Zika Syndrome

Conditions
-----------------
Zika Virus, Congenital Zika Syndrome, Congenital Infection, Child Development

Intervention / Treatment
-----------------
* Other: Neurodevelopmental assessments


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Zika-exposed cohort: born to mothers with Zika lab confirmation by PCR, IgM, and/or PRNT, or mother was symptomatic for Zika but infection could not be excluded due to late testing and evaluated at Children's National, Washington, DC (USA) or at BIOMELAB, Barranquilla (Colombia) normal fetal neuroimaging normal birth head circumference normal birth clinical exam no more than mild non-specific postnatal cranial ultrasound or brain MRI findings during infancy (if performed) able to be contacted for follow-up Non-ZIKV exposed Controls: healthy no chronic medical conditions no developmental concerns born at term (>= 37 weeks) birth date prior to March 31, 2016 (Colombian controls) Exclusion Criteria: Zika-exposed cohort: another diagnosis that would impact neurodevelopment abnormal brain MRI (non-specific mild findings are not an exclusion criteria) Non-ZIKV exposed controls: chronic medical condition with in-patient hospitalization since birth under care of a medical specialty provider for a chronic medical condition surgery with general anesthesia since birth (brief anesthesia for ear tubes, tonsillectomy, or other minor pediatric procedure is not an exclusion criteria) history of seizure abnormal vision (children wearing corrective lenses are eligible) abnormal hearing affecting language development developmental concerns expressed by caregiver receiving physical, occupational, speech or developmental therapy receiving special education services in school behavioral or psychological condition birth date March 31, 2016 or later (Colombian controls) preterm birth (≤36 weeks) planned relocation of child within 5 years and likely inability to complete study

Ages Eligible for Study
-----------------
Minimum Age: 3 Years
Maximum Age: 6 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Colombia ZIKV-exposed<br>Seventy children in Colombia were previously enrolled as part of a fetal-neonatal neuroimaging study in 2016-2017 and were from Department of Atlantico, Colombia on the Caribbean coast. Eligible children had prior normal fetal MRI and fetal US, normal birth head circumference, normal clinical exam, no more than mild non-specific postnatal imaging findings, and are thus without findings of CZS. | Other: Neurodevelopmental assessments<br>* The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams. At age 7 years, the children will have a non-sedated quantitative brain MRI.<br>|
| Colombia Non-ZIKV exposed control<br>The investigators will enroll 70 non-ZIKV exposed children, age 4 to 5 years, in Department of Atlántico, Colombia with birth dates prior to March 31, 2016. Based on the arrival of ZIKV to Colombia in November 2015, this date would ensure a control cohort without congenital ZIKV exposure in the first half of gestation and unlikely during any of the pregnancy. | Other: Neurodevelopmental assessments<br>* The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams. At age 7 years, the children will have a non-sedated quantitative brain MRI.<br>|
| United States ZIKV-exposed<br>The US cohort either presented during pregnancy or after birth and sought clinical care with the Children's National Congenital Zika Program in Washington, DC and were ZIKV-exposed. | Other: Neurodevelopmental assessments<br>* The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams. At age 7 years, the children will have a non-sedated quantitative brain MRI.<br>|
| United States Non-ZIKV exposed control<br>The investigators will enroll 32 non-ZIKV exposed children, age 4 years, in Washington, DC. | Other: Neurodevelopmental assessments<br>* The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams. At age 7 years, the children will have a non-sedated quantitative brain MRI.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neurodevelopmental assessment at age 4 years | PEDI-CAT score | 4 years of age | 
| Executive function | BRIEF-2 score | 5 and 7 years of age | 
| Motor function assessment | MABC-2 score | 5 and 7 years of age | 
| Brain maturation | Quantitative brain MRI volumetric measurement | 7 years of age | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Motor function assessment | MABC-2 score | 4 years of age | 
| Intellectual ability | Age-appropriate Wechsler | 5 and 7 years of age | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
ZIKV