- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04398901
Neurodevelopmental Outcomes in ZIKV-Exposed Children
Developmental Outcome After In Utero ZIKV Exposure in Children Without Congenital Zika Syndrome
Study Overview
Status
Intervention / Treatment
Detailed Description
Zika-virus (ZIKV) infection in pregnancy can result in severe brain damage in 4-12% of cases. Children exposed to ZIKV in utero during the years of 2015-2017 are now in early childhood. Children with severe neurologic injury (Congenital Zika Syndrome; CZS) have a poor developmental outcome, however the developmental outcome of apparently normal infants following in utero ZIKV-exposure is not well known. The incidence of abnormal neurodevelopmental outcome in apparently normal children with in utero ZIKV-exposure is not known.
The investigators will determine if neurodevelopmental assessment scores in children exposed to ZIKV in utero who are normal appearing differ from norms. The investigators hypothesize that ZIKV-exposed normal appearing children will have lower multi-domain developmental assessment scores compared to normative samples. The investigators hypothesize that the presence of mild postnatal non-specific cranial US findings is associated with persistent lower developmental assessment scores compared to ZIKV-exposed children who had normal cranial US and quantitative imaging will find structural and functional brain differences between ZIKV-exposed children and controls..
The investigators will perform a prospective developmental outcome study at 2 sites: 1) Department of Atlántico, Colombia through collaboration with BIOMELAB, the research center of Dr. Carlos Cure, and 2) Children's National, Washington, DC.
The objective of the study is to determine whether children who were exposed to ZIKV in utero and who do not have CZS have abnormalities in neurodevelopment during early childhood and at school age.
The primary outcome at early childhood will be neurodevelopmental assessment scores at age 3 and 4 years. Scores will be compared between Zika-exposed children and controls. The primary outcome at school age will be neurodevelopmental assessment scores at age 5 and 7 years and quantitative brain MRI at 7 years.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
-
-
Atlantico
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Barranquilla, Atlantico, Colombia
- BIOMELAB
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-
-
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District of Columbia
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Washington, District of Columbia, United States, 20010
- Children's National Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
Zika-exposed cohort:
- born to mothers with Zika lab confirmation by PCR, IgM, and/or PRNT, or mother was symptomatic for Zika but infection could not be excluded due to late testing and evaluated at Children's National, Washington, DC (USA) or at BIOMELAB, Barranquilla (Colombia)
- normal fetal neuroimaging
- normal birth head circumference
- normal birth clinical exam
- no more than mild non-specific postnatal cranial ultrasound or brain MRI findings during infancy (if performed)
- able to be contacted for follow-up
Non-ZIKV exposed Controls:
- healthy
- no chronic medical conditions
- no developmental concerns
- born at term (>= 37 weeks)
- birth date prior to March 31, 2016 (Colombian controls)
Exclusion Criteria:
Zika-exposed cohort:
- another diagnosis that would impact neurodevelopment
- abnormal brain MRI (non-specific mild findings are not an exclusion criteria)
Non-ZIKV exposed controls:
- chronic medical condition with in-patient hospitalization since birth
- under care of a medical specialty provider for a chronic medical condition
- surgery with general anesthesia since birth (brief anesthesia for ear tubes, tonsillectomy, or other minor pediatric procedure is not an exclusion criteria)
- history of seizure
- abnormal vision (children wearing corrective lenses are eligible)
- abnormal hearing affecting language development
- developmental concerns expressed by caregiver
- receiving physical, occupational, speech or developmental therapy
- receiving special education services in school
- behavioral or psychological condition
- birth date March 31, 2016 or later (Colombian controls)
- preterm birth (≤36 weeks)
- planned relocation of child within 5 years and likely inability to complete study
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Colombia ZIKV-exposed
Seventy children in Colombia were previously enrolled as part of a fetal-neonatal neuroimaging study in 2016-2017 and were from Department of Atlantico, Colombia on the Caribbean coast.
Eligible children had prior normal fetal MRI and fetal US, normal birth head circumference, normal clinical exam, no more than mild non-specific postnatal imaging findings, and are thus without findings of CZS.
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The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams.
At age 7 years, the children will have a non-sedated quantitative brain MRI.
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Colombia Non-ZIKV exposed control
The investigators will enroll 70 non-ZIKV exposed children, age 4 to 5 years, in Department of Atlántico, Colombia with birth dates prior to March 31, 2016.
Based on the arrival of ZIKV to Colombia in November 2015, this date would ensure a control cohort without congenital ZIKV exposure in the first half of gestation and unlikely during any of the pregnancy.
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The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams.
At age 7 years, the children will have a non-sedated quantitative brain MRI.
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United States ZIKV-exposed
The US cohort either presented during pregnancy or after birth and sought clinical care with the Children's National Congenital Zika Program in Washington, DC and were ZIKV-exposed.
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The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams.
At age 7 years, the children will have a non-sedated quantitative brain MRI.
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United States Non-ZIKV exposed control
The investigators will enroll 32 non-ZIKV exposed children, age 4 years, in Washington, DC.
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The investigators will evaluate multiple domains of neurodevelopment at age 3, 4, 5 and 7 years using parental questionnaires and child exams.
At age 7 years, the children will have a non-sedated quantitative brain MRI.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Neurodevelopmental assessment at age 4 years
Time Frame: 4 years of age
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PEDI-CAT score
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4 years of age
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Executive function
Time Frame: 5 and 7 years of age
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BRIEF-2 score
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5 and 7 years of age
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Motor function assessment
Time Frame: 5 and 7 years of age
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MABC-2 score
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5 and 7 years of age
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Brain maturation
Time Frame: 7 years of age
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Quantitative brain MRI volumetric measurement
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7 years of age
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Motor function assessment
Time Frame: 4 years of age
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MABC-2 score
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4 years of age
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Intellectual ability
Time Frame: 5 and 7 years of age
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Age-appropriate Wechsler
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5 and 7 years of age
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Sarah B Mulkey, MD, PhD, Children's National Research Institute
Publications and helpful links
General Publications
- Mulkey SB, DeBiasi RL. Do Not Judge a Book by Its Cover: Critical Need for Longitudinal Neurodevelopmental Assessment of In Utero Zika-Exposed Children. Am J Trop Med Hyg. 2020 May;102(5):913-914. doi: 10.4269/ajtmh.20-0197. No abstract available.
- Mulkey SB, Bulas DI, Vezina G, Fourzali Y, Morales A, Arroyave-Wessel M, Swisher CB, Cristante C, Russo SM, Encinales L, Pacheco N, Kousa YA, Lanciotti RS, Cure C, DeBiasi RL, du Plessis AJ. Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure. JAMA Pediatr. 2019 Jan 1;173(1):52-59. doi: 10.1001/jamapediatrics.2018.4138.
- Mulkey SB, Arroyave-Wessel M, Peyton C, Bulas DI, Fourzali Y, Jiang J, Russo S, McCarter R, Msall ME, du Plessis AJ, DeBiasi RL, Cure C. Neurodevelopmental Abnormalities in Children With In Utero Zika Virus Exposure Without Congenital Zika Syndrome. JAMA Pediatr. 2020 Mar 1;174(3):269-276. doi: 10.1001/jamapediatrics.2019.5204. Erratum In: JAMA Pediatr. 2020 Mar 1;174(3):305.
- Mulkey SB, Ansusinha E, Cristante C, Russo SM, Biddle C, Kousa YA, Pesacreta L, Jantausch B, Hanisch B, Harik N, Hamdy RF, Hahn A, Chang T, Jaafar M, Ambrose T, Vezina G, Bulas DI, Wessel D, du Plessis AJ, DeBiasi RL. Complexities of Zika Diagnosis and Evaluation in a U.S. Congenital Zika Program. Am J Trop Med Hyg. 2021 Apr 19;104(6):2210-2219. doi: 10.4269/ajtmh.20-1256.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00012759
- 1R01HD102445-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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