Objective Zika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls. Design Cohort study. Setting Public health centres in Grenada, West Indies. Patients 384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum. Main outcome measures The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status. Results A total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays. Conclusions Overall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age. Data are available on reasonable request.

中文翻译：

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有和没有产前寨卡病毒暴露的正常头颅儿童的神经发育

目的 寨卡病毒 (ZIKV) 靶向发育中大脑中的神经干细胞。然而，大多数 ZIKV 暴露儿童出生时没有明显的神经系统表现。目前尚不清楚这些儿童是否受到了寨卡病毒嗜神经性保护，或者他们是否存在破坏大脑发育的微妙病理。我们通过比较正常头颅 ZIKV 暴露儿童相对于未暴露对照组的平行对照组的神经发育结果来评估这一点。设计队列研究。在西印度群岛的格林纳达设立公共卫生中心。患者 在 ZIKV 传播活跃期间（2016 年 4 月至 2017 年 3 月）招募了 384 对母子，并进行了长达 30 个月的前瞻性随访。儿童暴露状况基于产前和产后母体血清的实验室评估。主要结果测量 INTERGROWTH-21st 神经发育评估 (INTER-NDA) 包和卡迪夫视力测试，由隐藏儿童暴露状态的研究人员进行管理和评分。结果 对 22 至 30 个月大的 131 名正头颅 ZIKV 暴露 (n=68) 和未暴露 (n=63) 儿童进行了评估。这些儿童中大约有一半完成了视力测试。社会人口统计学方面没有群体差异。在没有认知、运动、语言或行为延迟的情况下，ZIKV 暴露婴儿的视力（31%）和对比敏感度（23%）缺陷很明显。结论 出生时头围正常且头两年头部生长正常的寨卡病毒暴露儿童的整体神经发育可能不受影响。然而，视觉系统可能会选择性地受到攻击，这表明需要在 3 岁之前进行视力测试。可应合理要求提供数据。