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PLoS Negl Trop Dis. 2014 Jul 17;8(7):e2996. doi: 10.1371/journal.pntd.0002996. eCollection 2014.

Neurocognitive outcome of children exposed to perinatal mother-to-child Chikungunya virus infection: the CHIMERE cohort study on Reunion Island.

Author information

  • 1CHU de La Réunion Saint-Denis/Saint-Pierre, La Réunion, France; INSERM CIC-EC (CIE2), Saint-Pierre, La Réunion, France; INSERM UMRS 953, "Epidemiological Research Unit on Perinatal Health and Women and Children Health", UPMC Université Paris 6, Paris, France.
  • 2CHU de La Réunion Saint-Denis/Saint-Pierre, La Réunion, France.
  • 3CHU de La Réunion Saint-Denis/Saint-Pierre, La Réunion, France; INSERM CIC-EC (CIE2), Saint-Pierre, La Réunion, France; GRI, Research Group on Immunopathology and Infection, EA4517, Université de La Réunion, INSERM UMRS 945 "Immunity and Infection" Saint-Denis, La Réunion, France.
  • 4Centre Hospitalier Gabriel Martin, Saint-Paul, La Réunion, France.
  • 5Centre Hospitalier de l'Est Réunion, Saint-Benoît, La Réunion, France.
  • 6Clinique Sainte-Clotilde, Sainte-Clotilde, La Réunion, France.
  • 7Clinique Durieux, Le Tampon, La Réunion, France; Centre d'Action Médico-Sociale Précoce (CAMSP), Saint-Louis, La Réunion, France.
  • 8INSERM CIC-EC (CIE2), Saint-Pierre, La Réunion, France.
  • 9INSERM UMRS 953, "Epidemiological Research Unit on Perinatal Health and Women and Children Health", UPMC Université Paris 6, Paris, France.
  • 10INSERM UMRS 953, "Epidemiological Research Unit on Perinatal Health and Women and Children Health", UPMC Université Paris 6, Paris, France; Poitiers University Hospital, Poitiers, France; INSERM CIC-P 0802, Poitiers, France.

Abstract

BACKGROUND:

Little is known about the neurocognitive outcome in children exposed to perinatal mother-to-child Chikungunya virus (p-CHIKV) infection.

METHODS:

The CHIMERE ambispective cohort study compared the neurocognitive function of 33 p-CHIKV-infected children (all but one enrolled retrospectively) at around two years of age with 135 uninfected peers (all enrolled prospectively). Psychomotor development was assessed using the revised Brunet-Lezine scale, examiners blinded to infectious status. Development quotients (DQ) with subscores covering movement/posture, coordination, language, sociability skills were calculated. Predictors of global neurodevelopmental delay (GND, DQ ≤ 85), were investigated using multivariate Poisson regression modeling. Neuroradiologic follow-up using magnetic resonance imaging (MRI) scans was proposed for most of the children with severe forms.

RESULTS:

The mean DQ score was 86.3 (95%CI: 81.0-91.5) in infected children compared to 100.2 (95%CI: 98.0-102.5) in uninfected peers (P<0.001). Fifty-one percent (n = 17) of infected children had a GND compared to 15% (n = 21) of uninfected children (P<0.001). Specific neurocognitive delays in p-CHIKV-infected children were as follows: coordination and language (57%), sociability (36%), movement/posture (27%). After adjustment for maternal social situation, small for gestational age, and head circumference, p-CHIKV infection was found associated with GND (incidence rate ratio: 2.79, 95%CI: 1.45-5.34). Further adjustments on gestational age or breastfeeding did not change the independent effect of CHIKV infection on neurocognitive outcome. The mean DQ of p-CHIKV-infected children was lower in severe encephalopathic children than in non-severe children (77.6 versus 91.2, P<0.001). Of the 12 cases of CHIKV neonatal encephalopathy, five developed a microcephaly (head circumference <-2 standard deviations) and four matched the definition of cerebral palsy. MRI scans showed severe restrictions of white matter areas, predominant in the frontal lobes in these children.

CONCLUSIONS:

The neurocognitive outcome of children exposed to perinatal mother-to-child CHIKV infection is poor. Severe CHIKV neonatal encephalopathy is associated with an even poorer outcome.

PMID:
25033077
[PubMed - indexed for MEDLINE]
PMCID:
PMC4102444
Free PMC Article
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