Risco de disfagia em crianças com a Síndrome Congênita do Zika Vírus em Salvador: um estudo exploratório.

Abstract

Introduction: The Congenital Zika Virus Syndrome (CZVS) is composed of five specific characteristics that differentiates it from other congenital infections: severe microcephaly with partial collapse of the skull, congenital contractures, early hypertonia and symptoms of extrapyramidal involvement, macular scarring and focal pigmentary retinal mottling, and fine cerebral cortex with subcortical calcifications. Those characteristics have direct interference with child development, and can cause cognitive, sensory and motor impairment. These children's growth are often accompanied with an increased tendency of neurological symptoms to worsen - with dysphagia being one of the most cited clinical findings. However, it was possible to identify only a few studies discussing the impact of dysphagia as being a characteristic comorbidity in CZVS’s population. Objective: Analyze risk of dysphagia in children with Congenital Zika Virus Syndrome, considering the existence of neuroanatomical alterations and the social status of the families. Methodology: This is a cross-sectional, exploratory, descriptive study, part of a bigger cohort “Effects of congenital neurological manifestations associated with the Zika virus on cognitive development in children: A prospective cohort study under the context of Primary Care in Salvador”, the study analyzed the data of 134 children. Data about the risk of dysphagia was collected from the questionnaire Pediatric Dysphagia Risk Screening Instrument (PDRSI); socioeconomic status information was collected by applying a Sociodemographic Assessment Questionnaire developed by the researchers; and information about neuroanatomical alterations were obtained from the databank of epidemiological investigation conducted by the Center for Strategic Information on Health Surveillance of the Municipal Health Secretariat of Salvador (CSIHS/MHS/SSA). Descriptive analysis of dysphagia risk and the included co-variables were studied based on their simple and relative distribution frequencies. Subsequently, Chi-square distribution test and Fisher’s exact test were used to estimate the differences between groups at risk of dysphagia and those without risk of dysphagia - considering sociodemographic characteristics and neuroanatomical alterations. For all analyses, STATA version 12 was used. Results: A dysphagia risk prevalence was found in 76.87% of children with CZVS in this study, mostly female between 31 to 42 months old, with a family income of up to 1 minimum wage, the most of the caregivers were mothers - in general black and brown having high school or higher education, and beneficiaries of the Continuous Provision Benefit (CPB). When comparing the risk of dysphagia according to neuroanatomical and socioeconomic variables, a higher prevalence dysphagia risk was found amongst CBP beneficiary children (62.14%), those had ventriculomegaly (66.67%) and records of three to six neuroanatomical alterations (91.67%). Conclusion: The presence of ventriculomegaly, three to six neuroanatomical alterations and access to the BPC data corroborate with the dysphagia higher risk among the children found in the study, this data allowed the recognition of more relevant groups for early intervention, which can have lasting benefits throughout the course of child development with CZVS.