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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

Event

When

Where

Activity

Accomplished

Childbirth care

Date of birth

Maternity hospital

Physical examination (measurement of head circumference, weight, height, and Apgar scores (1 and 5 min)

10 (91%)

Maternity hospital

Immediate collection of biological material for laboratory tests

9 (82%)

Newborn care

Between 24 and 48 h after birth

Maternity hospital

Repeat head circumference measurement

10 (91%)

Specialized center

Nonspecific 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 center

Specific laboratory tests for the specific diagnosis of ZIKV

10 (91%)

Specialized center

Imaging tests (transfontanelle ultrasound; non-contrast-enhanced computed tomography of the skull)

11 (100%)

Preferably within 24 and 48 h after birth

Preferably in the maternity hospital

Hearing screening tests - “Ear Test”

11 (100%)

Maternity hospital, PHCI, SRC with visual screening modalities, or specialized services for ophthalmology

Newborn eye screening tests - “Eye test” (ectoscopy and red reflex)

11 (100%)

Maternity hospital

Guidance to the family regarding the scheduling in PHCI for childcare follow-up

7 (64%)

Maternity hospital or PHCI

Guidance for attending an RCSA for follow-up for the support and social protection of children and families

3 (27%)

Up to the first month of life

Maternity hospital or PHCI

Refer to SRC to start early neuromotor stimulation

10 (91%)

Child follow-up

Weekly during the first month of life

Maternity hospital, PHCI, SRC, or specialized services

Repeat head circumference measurement

10 (91%)

Not later than the first month of life, except when the child’s health does not allow the examination

SRC with hearing screening modalities or high-complexity hearing rehabilitation center

Hearing function screening tests - Brainstem Auditory Evoked Potential

11 (100%)

After discharge from the hospital/maternity

SRC with visual screening modalities or specialized services in ophthalmology

Fundus 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 nursing

From the 10th day after birth, monthly consultations until 6th month of life.

From the 6th to the 12th month of life, quarterly consultations.

PHCI

Childcare consultations

6 (55%)

Specialized monitoring

3 years of age

SRC

Follow-up by a multidisciplinary team (physiotherapist, speech therapist, occupational therapist, and neuropediatrician)

10 (91%)

SRC

Assessment: 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%)

SRC

Stimulation: auditory, visual, motor function, manual function, cognitive and social skills, language, and orofacial motricity.

10 (91%)

SRC

Assistive technologies: upper limb orthoses and gait, postural adequacy, play adaptations, communication adaptations, low vision adaptations, adaptations for activities of daily living.

10 (91%)

SRC

Issuance of a medical report certifying CZS (necessary to request social benefits)

6 (55%)

 

SRC

Therapeutic support for the mother and family (health education and rehabilitation team guidance, psychotherapeutic support, and social assistance)

0 (0%)

Social assistance

 

SRC, PHCI, and RCSA

Systematic monitoring to ensure social protection and reduce vulnerability

5 (45%)

 

RCSA

Inclusion to receive social assistance services

6 (55%)

 

SRC, PHCI, and RCSA

Guidance on assistance benefits, including the possibility of applying to the National Institute of Social Security for Continuous Benefit, if the necessary criteria are met

6 (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