Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome.

Autor: van der Linden V; Association for Assistance of Disabled Children, Recife, Brazil.; Barāo de Lucena Hospital, Recife, Brazil., Lins OG; Federal University of Pernambuco, Recife, Brazil., de Lima Petribu NC; Barāo de Lucena Hospital, Recife, Brazil., de Melo ACMG; Restauração Hospital, Recife, Brazil., Moore J; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia., Rasmussen SA; College of Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida.; College of Medicine and College of Public Health and Health Professions, Department of Epidemiology, University of Florida, Gainesville, Florida., Moore CA; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jazyk: angličtina
Zdroj: Birth defects research [Birth Defects Res] 2019 Nov 15; Vol. 111 (19), pp. 1577-1583. Date of Electronic Publication: 2019 Oct 09.
DOI: 10.1002/bdr2.1597
Abstrakt: Background: Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life-threatening respiratory insufficiency. The clinical diagnosis of unilateral diaphragmatic paralysis has been reported in infants with laboratory evidence of congenital Zika virus infection and/or the congenital Zika syndrome (CZS) phenotype but no evaluation of phrenic nerve function has been described. All reported infants have had accompanying arthrogryposis. High infant mortality is reported.
Methods: The causal mechanism of congenital diaphragmatic paralysis was evaluated in three infants with arthrogryposis as a manifestation of CZS (two of the three infants had laboratory evidence of ZIKV infection shortly after birth; the remaining infant had negative serology for ZIKV when first tested at 7 months of age). Electromyography and phrenic nerve compound muscle action potential (CMAP) were performed in all infants with diaphragmatic paralysis demonstrated on imaging studies.
Results: All infants had evidence of moderate chronic involvement of peripheral motor neurons. Phrenic nerve CMAP was reduced on the side of the diaphragmatic paralysis in two infants and reduced bilaterally in the remaining infant who had primarily anterior involvement of the diaphragm. All three infants had multiple medical complications and one infant died at 18 months of age.
Conclusion: Evaluation of three infants with CZS and diaphragmatic paralysis demonstrated phrenic nerve dysfunction. In these and other affected infants, arthrogryposis appears to be a constant co-occurring condition and health problems are significant; both conditions are likely due to involvement of the peripheral nervous system in some infants with CZS.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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