Costa Monteiro L M: Poster 1
National Institute of Women, Adolescent and Child Health Fernandes Figueira, Brazil
Title: Evaluation of urological outcomes in children exposed to fetal infection by Zika virus
Biography:
Lucia M. Costa Monteiro, M.D, Ph.D., works at Instituto Fernandes Figueira/Fiocruz (www.iff.fiocruz.br), the Brazilian National Institute of Health for Women, Children and Adolescents. Her research interest is neurogenic bladder and voiding dysfunction and since 1998 has been the research group leader: (http://dgp.cnpq.br/dgp/espelhogrupo/3929782950316727). From 2002-2004 she collaborated/worked as a research associated at the Children's National Medical Center. Member of the International Children's Continence Society and Member of Editorial Board Member of Editorial Board of Revista Brasileira de Saúde Materno Infantil (2006), Jornal de Pediatria (2008) and SM Journal of Nephrology and Kidney Diseases (2017).
Most recent publication: Early treatment improves urodynamic prognosis in neurogenic voiding dysfunction: 20 years of experience. J Pediatr (Rio J). 2017 Jul - Aug;93(4):420-427. doi: 10.1016/j.jped.2016.11.010. Epub 2017 Apr 19.
Abstract:
Background & Aim: Zika virus is a mosquito borne flavivirus that may affect pregnant women and their infants by causing fetal abnormalities. This Congenital Zika Syndrome (CZS) is associated with microcephaly and central nervous systems malformations. We identified that some of the regions damaged by CZS are also known to influence the neural circuitry controlling the lower urinary tract. The goal is to investigate an association of CZS and neurogenic urinary tract dysfunction to increase knowledge in the field and mitigate the impact of the disease in infected children.
Methods: Urological assessment was performed in pediatric patients with confirmed CZS referred to our Urology Clinic between June 2016 and June 2017. It consisted of clinical history, laboratory tests, renal ultrasound and urodynamic evaluation. ZIKV was previously confirmed by maternal history and positive PCR in babies/mothers. Microcephaly and other CNS abnormalities were established based on neurological and image evaluation (CT and/or MRI).
Findings: Twenty eight CZS patients were tested, 15 females and 13 males, age 10 months old in average (ranging from 2 mo to 19 mo old). All were presented with microcephaly. Urological assessment confirmed neurogenic urinary tract dysfunction in 100%, some with high risk profile. Most were asymptomatic but urological screening confirmed urinary tract infection in 5 and renal US were already abnormal in 3 patients.
Conclusion: Urological comorbidities are associated with congenital Zika syndrome, including high risk urodynamic patterns that can cause renal damage if left untreated. This is potentially the only treatable health condition in CZS setting and neonatologist and pediatricians need to be aware to promote proactive management that mitigates disease burden to patients and their families.