Estudo do desempenho motor grosso de lactentes com microcefalia por zika vírus

Abstract

Introduction: In the year 2015, there was an increase in microcephaly cases in Brazil related to vertical transmission of Zika virus (ZIKV). Congenital Zika Virus Syndrome (SCZ) is characterized by microcephaly and several other symptoms, including altered neuromotor development. Children affected by them require monitoring by a multidisciplinary team in early intervention programs. Objectives: I) to characterize the gross motor performance of infants with microcephaly due to ZIKV infection, comparing it to infants without involvement; II) to identify opportunities for motor stimulation in the home environment; and III) to identify the impact of early intervention programs on the development of children with SCZ. Methods: The proposed methodology involved an observational, unpaired case-control study and a systematic literature review. In the case-control study, 40 infants with microcephaly due to ZIKV infection (GM) and 40 infants without microcephaly (CG), seen at public services in the states of Alagoas and Sergipe, participated. Maternal birth, gestational and sociodemographic data of the infants were collected, and the following tests were applied: Gross Motor Function Measure (GMFM), Affordances in the Home Environment for Motor Development (AHEMD), and Gross Motor Function Classification System (GMFCS). Fisher's exact test for continuous variables, the t-test for independent samples, and univariable and multivariable linear regression were used for the analyses. An alpha value of 5% was adopted. SPSS v 21.0 was used. In the systematic review, studies were collected in October 2020 in the databases: PubMed, SciELO, LILACS, SCOPUS, Web of Science, EMBASE, PsycINFO, CINHAL, using the MeSH terms "zika virus infection", "early educational intervention", "rehabilitation", "child development", "infant" and "child", as well as the corresponding synonyms/keywords. Results: In the case-control study, significant differences (p<0.001) between groups were evidenced for all dimensions of GMFM and AHEMD, with values always lower in GM. Level V of the GMFCS occurred in 85% of the infants with microcephaly due to ZIKV, considered the level of greatest motor impairment. The CG showed 190.5 points more than the GM (p<0.001) in the GMFM, and the "Group" model proved to be a good explanatory factor. Maternal sociodemographic data, such as income and residence, are the main determinants for AHEMD scores. In the systematic review, four studies were included, addressing the following early intervention programs: intensive physical therapy training with therapeutic dressing, a program based on the GAME protocol, and conventional multidisciplinary therapy. These studies evidenced impaired motor and cognitive development, stabilization or little improvement in motor skills and functional performance of children with SCZ, even after these interventions. The program based on the GAME protocol showed positive impacts on family participation in the care provided to infants with SCZ. Conclusion: Infants with microcephaly due to ZIKV showed severe impairment of gross motor development and low opportunities for motor stimulation in the home environment. In parallel, a lack of publications on early intervention programs for this population was identified. We foresee the need to develop new early intervention programs that provide positive impacts for the development of this population.