Neurocognitive Outcome of Children Exposed to Perinatal Mother-to-Child Chikungunya Virus Infection: the CHIMERE Cohort Study on Reunion Island

Background:little is known about the neurocognitive outcome in children exposed to perinatal mother-to-child chikungunya virus (p-chikv) infection.methods:the chimere ambispective cohort study compared the neurocognitive function of 33 p-chikv-infected children (all but one enrolled retrospectively) at around two years of age with 135 uninfected peers (all enrolled prospectively). psychomotor development was assessed using the revised brunet-lezine scale,examiners blinded to infectious status. development quotients (dq) with subscores covering movement/posture,coordination,language,sociability skills were calculated. predictors of global neurodevelopmental delay (gnd,dq≤85),were investigated using multivariate poisson regression modeling. neuroradiologic follow-up using magnetic resonance imaging (mri) scans was proposed for most of the children with severe forms.results:the mean dq score was 86.3 (95%ci: 81.0-91.5) in infected children compared to 100.2 (95%ci: 98.0-102.5) in uninfected peers (p<0.001). fifty-one percent (n = 17) of infected children had a gnd compared to 15% (n = 21) of uninfected children (p<0.001). specific neurocognitive delays in p-chikv-infected children were as follows: coordination and language (57%),sociability (36%),movement/posture (27%). after adjustment for maternal social situation,small for gestational age,and head circumference,p-chikv infection was found associated with gnd (incidence rate ratio: 2.79,95%ci: 1.45-5.34). further adjustments on gestational age or breastfeeding did not change the independent effect of chikv infection on neurocognitive outcome. the mean dq of p-chikv-infected children was lower in severe encephalopathic children than in non-severe children (77.6 versus 91.2,p<0.001). of the 12 cases of chikv neonatal encephalopathy,five developed a microcephaly (head circumference <-2 standard deviations) and four matched the definition of cerebral palsy. mri scans showed severe restrictions of white matter areas,predominant in the frontal lobes in these children.conclusions:the neurocognitive outcome of children exposed to perinatal mother-to-child chikv infection is poor. severe chikv neonatal encephalopathy is associated with an even poorer outcome. © 2014 gérardin et al.