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Can the Zika Virus Lead to Microcephaly Birth Defect?
NURS 222
Date
Can the Zika Virus Lead to Microcephaly Birth Defect?
Part 1: Citations and Annotations
Honein, M. A., Dawson, A. L., Petersen, E. E., Jones, A. M., Lee, E. H., Yazdy, M. M.,…
Jamieson, D. J. (2017). Birth defects among fetuses and infants of US Women with evidence of possible Zika virus infection during pregnancy. Jama, 317(1), 59-68. doi:10.1001/jama.2016.19006
This is a primary source since the researchers conducted the study from scratch. The research looked for the incidences of Zika virus associated birth defects in the fetus or infants by analyzing the data from the U.S. Zika Pregnancy Registry (USZPR). The result showed that microcephaly birth defect occurred in 26 infants (6%) per 442 pregnancies with evidence of possible Zika virus infection. Also, about 11% had a fetus or infant with a birth defect when exposed to Zika virus during the first trimester. The strength of this article is using a large sample size of 442 pregnant women with possible Zika virus infection in the United States and also well discussion about the limitations such as the unreported case of birth defect associated with Zika virus, lack of diagnosis of the timing of the infection and incomplete information on other risk factors that associated with microcephaly. The weakness of this article is that it did not point out an existing research gap. Consequently, it exhibits selection bias regarding those included in the USZPR. Notably, health professionals are their target audience. Nurses can use this information to encourage those high-risk pregnant women for screening. Additionally, practitioners can use this information to educate patients about the relationship between the Zika virus and birth defect.
Karwowski, M. P., Nelson, J. M., Staples, J. E., Fischer, M., Fleming-Dutra, K. E., Villanueva,
J., & Rasmussen, S. A. (2016). Zika virus disease: A CDC update for pediatric health care providers. Pediatrics, 137(5), 1-15. doi:10.1542/peds.2016-0621
This article introduces the necessary information about Zika virus and emphasizes the founding of Zika virus in the fetus and infants. The diagnostic testing proved that the Zika virus is found in the brain tissue of the newborn with microcephaly. Its strengths include employing the findings of multiple studies in Brazil and the United States to support the relationship between the Zika virus and congenital microcephaly. On the other hand, the articles’ weakness is that the studies it used had a small sample size. Notably, the report does not have any considerable bias. The United Stated pediatric health care providers are its target audience, and nurses can use its information to familiarize with the Zika virus infection especially its impact in pediatrics. Additionally, practitioners can use the information to assist health care providers in managing Zika virus infection in newborns and children.
Reynolds, M. R., Jones, A. M., Petersen, E. E., Lee, E. H., Rice, M. E., Bingham, A.,…Honein,
- A. (2017). Vital signs: Update on Zika virus–associated birth defects and evaluation of all U.S. infants with congenital Zika virus exposure — U.S. Zika pregnancy registry, 2016. Morbidity and Mortality Weekly Report, 66(13), 366-373. doi:10.15585/mmwr.mm6613e1
This article reported the association between Zika virus infection and its effect on pregnancy. The research study used a total sample size of 1297 pregnancies with possible Zika virus infection from the U.S. Zika Pregnancy Registry (USZPR). There were 972 completed pregnancies among the1297 pregnancies, and 51 birth defect cases reported from the 972 completed pregnancies. The use of a large sample size (n= 1297), use the data to analyze the correlation concisely, and the inclusion of the study’s limitations are the strengths of this article. Nevertheless, the failure to suggest future research is a major weakness of the study. Moreover, the sample selection technique is biased. Healthcare professionals and pregnant women who are at risk for Zika virus infection are the target audience. The nurse can use this information to educate high-risk pregnant women for proper screening and to follow the guideline from the CDC in managing the Zika virus in pregnancy. Additionally, they can employ the data to differentiate infants who needed for screening and to know the initial evaluation for high-risk infants.
Rice, M. E., Galang, R. R., Roth, N. M., Ellington, S. R., Moore, C. A., Valencia-Prado, M.,…
Honein, M. A. (2018). Vital Signs: Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection — U.S. Territories and Freely Associated States, 2018. Morbidity and Mortality Weekly Report, 67(31), 858-867. doi:10.15585/mmwr.mm6731e1
This article reported a research study of Zika virus associated birth defects and neurodevelopmental abnormalities in the U.S. The result showed that approximately one in seven infants identified Zika virus associated birth defects from pregnancies infected with the virus. The primary strength of this study is that it focuses on a large sample size. Consequently, its weakness is that it lacks the board range of neurodevelopmental abnormalities from Zika infected pregnancies and it only selected abnormalities from consistently reported such as microcephaly. Importantly, no bias was identified. The audience of this article is all the health care professionals and pregnant women who infected with Zika virus. The nurse can use this information to be more caution in monitoring infants born to mothers with Zika virus infection. This information can also help the nurse in the early detection of abnormalities in infants.
Simon, R. B., & Carpenetti, T. L. (2016). Zika virus facing a new threat. Nursing2016, 46(8),
24-31. doi:10.1097/01.NURSE.0000484957.70486.d0
The article discusses the various aspects of the Zika virus including its epidemiology, pathophysiology, transmission, symptoms, diagnosis and testing, and treatment and prevention. Zika virus is associated with Microcephaly, which possibly caused by direct transfer and by placental mediation. However, the study stated that the relationship between Zika and microcephaly is not yet clear. The strength of this article includes that the authors used data from the CDC and WHO to support their claim. Additionally, they offered detailed information such as pathophysiology, transmission, and prevention of Zika virus. On the other hand, the research’s weakness is that it lacks data that associates Zika related microcephaly in the United States. No bias was identified. Notably, nurses and other healthcare professionals are the primary target audience of this research. Nurses can use this information to determine the disease and to educate patients about the cause, diagnosis, and prevention of Zika virus infection. Moreover, they can use the information in assessing the risk of pregnant women with a history of travel to the areas with active virus infection.
Part 2: Analysis
A recent outbreak of Zika virus in Brazil has caught the attention of researchers due to the increasing number of microcephaly (6776 possible cases) reported between 2015 and 2016 during the outbreak. A large number of microcephaly cases highlight the possibility of prenatal transmission of Zika virus. Microcephaly could cause long-term developmental problems on children such as hearing loss, intellectual disability, slow growth, and speech impairment. The question of whether Zika virus could cause a birth defect in fetus via prenatal transmission needs attention from all the healthcare profession and pregnant women. If Zika virus infection is related to microcephaly birth defect, the healthcare system would need to modify the treatment plan in managing pregnant women with confirmed Zika virus infection and infant with birth defect associated with Zika virus such as microcephaly. Importantly, the healthcare system would need to develop a prevention plan for healthy pregnant women in preventing the Zika virus.
The Jama article established that 6% of the fetus had Zika related birth defect and 85% of these fetuses had microcephaly with brain abnormalities (Honein et al., 2017, p.62). Additionally, the researchers found that there were no reports of Zika virus related birth defect in infants with prenatal exposure to Zika virus in the second and third trimester. In contrast, there were 11% of birth defects associated with pregnancies with exposure to the virus in the first trimester. In conclusion, the study emphasizes the importance of screening for high-risk pregnant women and women with confirmed Zika infection. Also, it suggests they avoid traveling to areas with active Zika virus and to use proper protection during sex. Base on the information, it can indicate that Zika virus infection can pass through fetus and cause a birth defect.
The pediatric article established that Zika virus is found in infants with microcephaly by using laboratory testing. Additionally, it suggests microcephaly might be associated with other prenatal risk factors such as alcohol, genetics, and mercury (Karwowski et al., 2016, p.3). According to the authors, “it is unclear whether other central nervous system manifestations beyond microcephaly might occur” (Karwowski et al., 2016, p.3). As such, they concluded that neonates born to women with exposure of Zika virus are at risk for microcephaly. Moreover, Zika virus infection seems to relate to microcephaly and other birth defects. Base on the information, there is a big possibility that Zika virus is associated with microcephaly.
The article from MMWR (2017) is an original research report. The study established that about 5% (N=51) of birth defect found in 972 completed pregnancies with possible Zika virus infection. Within the 51 fetus or infants, about 84% has microcephaly and brain abnormalities (Reynolds et al., 2017, p.368). They also found a higher report rate of birth defect with women infected in their first trimester. In this regard, the researchers concluded that there is a strong association between pregnant women with possible Zika virus infection and Zika virus related birth defects. The article also recommended following the CDC guidelines in managing for pregnant women and infant with the possible viral infection.
The article from MMWR (2018) is also a primary research article. The result of the study depicted that 203 (14%) children had Zika associated birth defect in the 1450 children with women who had a confirmed infection. All 1450 children had at least one follow up care after the age of 14 days, which is documented and reported to the U.S. Zika Pregnancy and Infant Registry. As such, this article concludes that Zika virus in pregnancies can cause a severe birth defect in children; and therefore, screening and follow-up care are recommended for pregnant women and infants who infected with Zika virus. Base on the information, the data suggested that Zika virus has a severe effect on neonates and infants.
The Nursing 2016 article partially highlights a study in French Polynesia that established evidence of Zika virus in placental tissue and neural tissues of the neonate (Simon & Carpenetti, 2016, p.27). However, the causal relationship between Zika and microcephaly is not clear, but healthcare providers should be concern about the link between the two. The overall conclusion for this article is to encourage the need for research or investigation on how to prevent further Zika related microcephaly such as from immunization. Base on the information, Zika virus is believed to associate with microcephaly even though the knowledge of their causal relationship is limited.
Both of the MMWR articles and the JAMA article used data from the U.S. Zika Pregnancy Registry to analyze the result. Notably, their results were similar – they portrayed the severe impact of Zika virus on infants and neonates to cause microcephaly. Unlike the MMWR and JAMA articles, the pediatric research used several studies from outside of the United States to support that Zika virus can transmit through fetus during pregnancy. Similar to the pediatric article, Nursing 2016 also used data from other studies in foreign countries, and the United Stated to support the positive association between the Zika virus and microcephaly. However, articles from the Pediatrics, Jama and Nursing 2016 mentioned that due to limited data, the causal relationship between Zika and microcephaly remains unclear and there should have a further investigation in the medical research. All articles recommended following the CDC guidelines for interventions in preventing Zika virus infection, such as screening, avoid traveling to active Zika virus areas, use protective sex, etc.
After reviewing all the literature, all the studies showing that the positive connection between Zika virus infection and microcephaly. The Nursing 2016 article stated that CDC has declared Zika virus is the cause of microcephaly congenital disability in infants (Simon & Carpenetti, 2016, p.27). Besides, laboratory testing has proven that Zika virus can pass to the fetus through the placenta. However, the causal relationship between the Zika virus and microcephaly remains unclear due to limited data. Nevertheless, nurses should use the information from the literature to educate the patient about the possibility of transmission of Zika virus to the fetus and emphasize that the infection could cause microcephaly if the fetus is infected. The practitioner should also educate the patient about the prevention of Zika virus to pregnant women with following the CDC guidelines. Notably, the literature increases the awareness of the transmission of Zika virus and its severe impact on fetus or infants to all the health care professions.