The birth prevalence of neonatal microcephaly and other central nervous system malformations greatly increased between 2015 and mid-2016 in Brazil.^1- 3 Several reports^1,2,4- 6 suggested an association between these findings and Zika virus (ZIKV) infection during outbreaks in Brazil and French Polynesia. Zika virus arrived in Brazil through the northeastern region and spread primarily to the states of Bahia, Pernambuco, and Paraíba.^7,8 It is a flavivirus transmitted by Aedes mosquitoes, and the infection in humans usually presents with 1 or more of the following symptoms: low-grade fever, arthralgia, rash, headache, and myalgia.^9,10 However, most infections are asymptomatic.² Neurological disorders associated with ZIKV infection include congenital microcephaly and adult manifestations such as Guillain-Barré syndrome, acute myelitis, and meningoencephalitis.^1,11- 13

We illustrate the spectrum of findings associated with congenital Zika virus infection in the Instituto de Pesquisa in Campina Grande State Paraiba in northeastern Brazil, where the congenital infection has been particularly severe. PurposeTo document the imaging findings associated with congenital Zika virus infection as found in the Instituto de Pesquisa in Campina Grande State Paraiba (IPESQ) in northeastern Brazil, where the congenital infection has been particularly severe.Materials and MethodsFrom June 2015 to May 2016, 438 patients were referred to the IPESQ for rash occurring during pregnancy or for suspected fetal central nervous system abnormality. Patients who underwent imaging at IPESQ were included, as well as those with documented Zika virus infection in fluid or tissue (n = 17, confirmed infection cohort) or those with brain findings suspicious for Zika virus infection, with intracranial calcifications (n = 28, presumed infection cohort). Imaging examinations included 12 fetal magnetic resonance (MR) examinations, 42 postnatal brain computed tomographic examinations, and 11 postnatal brain MR examinations. Images were reviewed by four radiologists, with final opinion achieved by means of consensus.ResultsBrain abnormal...

Objectives To determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks’ gestation. Design Randomised triple blind clinical trial. Setting A large tertiary teaching hospital in northeast of Brazil. Participants Women at 34-36 weeks of pregnancy at risk of imminent premature delivery. Interventions Betamethasone 12 mg or placebo intramuscularly for two consecutive days. Main outcomes measures Primary outcome was the incidence of respiratory disorders (respiratory distress syndrome and transient tachypnoea of the newborn). Secondary outcomes included the need for ventilatory support, neonatal morbidity, and duration of stay in hospital. Results 320 women were randomised, 163 of whom were assigned to the treatment group and 157 to the controls. Final analysis included 143 and 130 infants, respectively. The rate of respiratory distress syndrome was low (two (1.4%) in the corticosteroid group; one (0.8%) in the placebo group; P=0.54), while the rate of transient tachypnoea was high in both groups (34 (24%) v 29 (22%); P=0.77). There was no reduction in the risk of respiratory morbidity with corticosteroid use even after adjustment for subgroups of gestational age (34-34+6 weeks, 35-35+6 weeks, and ≥36 weeks). The adjusted risk of respiratory morbidity was 1.12 (95% confidence interval 0.74 to 1.70). The need for ventilatory support was around 20% in both groups. There was no difference in neonatal morbidity (88 (62%) v 93 (72%); P=0.08) or in the duration of stay in hospital between the two groups (5.12 v 5.22 days; P=0.87). Phototherapy for jaundice was required less often in babies whose mothers received corticosteroids (risk ratio 0.63, 0.44 to 0.91). Conclusions Antenatal treatment with corticosteroids at 34-36 weeks of pregnancy does not reduce the incidence of respiratory disorders in newborn infants. Trial registration Clinical Trials NCT00675246.