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Table 2 Frequency distribution of children with CZS according to the standard of care received (n = 11)

From: Health demands and care of children with congenital Zika syndrome and their mothers in a Brazilian state

EventWhenWhereActivityAccomplished
Childbirth careDate of birthMaternity hospitalPhysical examination (measurement of head circumference, weight, height, and Apgar scores (1 and 5 min)10 (91%)
Maternity hospitalImmediate collection of biological material for laboratory tests9 (82%)
Newborn careBetween 24 and 48 h after birthMaternity hospitalRepeat head circumference measurement10 (91%)
Specialized centerNonspecific laboratory tests for newborns: complete blood count, serum liver aminotransferase measurements (AST and ALT), bilirubin, LDH, C-reactive protein, ferritin, urea and creatinine, and others.11 (100%)
Specialized centerSpecific laboratory tests for the specific diagnosis of ZIKV10 (91%)
Specialized centerImaging tests (transfontanelle ultrasound; non-contrast-enhanced computed tomography of the skull)11 (100%)
Preferably within 24 and 48 h after birthPreferably in the maternity hospitalHearing screening tests - “Ear Test”11 (100%)
Maternity hospital, PHCI, SRC with visual screening modalities, or specialized services for ophthalmologyNewborn eye screening tests - “Eye test” (ectoscopy and red reflex)11 (100%)
Maternity hospitalGuidance to the family regarding the scheduling in PHCI for childcare follow-up7 (64%)
Maternity hospital or PHCIGuidance for attending an RCSA for follow-up for the support and social protection of children and families3 (27%)
Up to the first month of lifeMaternity hospital or PHCIRefer to SRC to start early neuromotor stimulation10 (91%)
Child follow-upWeekly during the first month of lifeMaternity hospital, PHCI, SRC, or specialized servicesRepeat head circumference measurement10 (91%)
Not later than the first month of life, except when the child’s health does not allow the examinationSRC with hearing screening modalities or high-complexity hearing rehabilitation centerHearing function screening tests - Brainstem Auditory Evoked Potential11 (100%)
After discharge from the hospital/maternitySRC with visual screening modalities or specialized services in ophthalmologyFundus examination - to assist in the differential diagnosis of congenital infections such as syphilis, toxoplasmosis and, cytomegalovirus, as well as the identification of other undetected changes in neonatal eye screening such as retinopathy and other congenital and hereditary eye disorders.11 (100%)
Neonatal nursingFrom the 10th day after birth, monthly consultations until 6th month of life.
From the 6th to the 12th month of life, quarterly consultations.
PHCIChildcare consultations6 (55%)
Specialized monitoring3 years of ageSRCFollow-up by a multidisciplinary team (physiotherapist, speech therapist, occupational therapist, and neuropediatrician)10 (91%)
SRCAssessment: audiological, ophthalmological, and motor functions (motricity, muscle tone, primitive reactions and reflexes, observation of motor development, and use of standardized motor measurement instruments)10 (91%)
SRCStimulation: auditory, visual, motor function, manual function, cognitive and social skills, language, and orofacial motricity.10 (91%)
SRCAssistive technologies: upper limb orthoses and gait, postural adequacy, play adaptations, communication adaptations, low vision adaptations, adaptations for activities of daily living.10 (91%)
SRCIssuance of a medical report certifying CZS (necessary to request social benefits)6 (55%)
 SRCTherapeutic support for the mother and family (health education and rehabilitation team guidance, psychotherapeutic support, and social assistance)0 (0%)
Social assistance SRC, PHCI, and RCSASystematic monitoring to ensure social protection and reduce vulnerability5 (45%)
 RCSAInclusion to receive social assistance services6 (55%)
 SRC, PHCI, and RCSAGuidance on assistance benefits, including the possibility of applying to the National Institute of Social Security for Continuous Benefit, if the necessary criteria are met6 (55%)
  1. Abbreviations: ALT Alanine aminotransferase, AST Aspartate aminotransferase, CZS Congenital Zika syndrome, ECU Emergency care unit, LDH Lactate dehydrogenase, PHCI Public health care institution, RCSA Reference center for social assistance, SRC Specialized rehabilitation center, ZIKV Zika virus