# Association between congenital Zika syndrome and hospitalizations during early childhood: a nationwide cohort study

## TL;DR

Children with Congenital Zika Syndrome are hospitalized 3 to 7 times more often and stay longer in the hospital compared to those without the syndrome during early childhood.

## Contribution

This study is the first to investigate and quantify hospitalization patterns in children with Congenital Zika Syndrome on a nationwide scale.

## Key findings

- Hospitalization rates for CZS children were 3.77 to 7.76 times higher than for non-CZS children.
- CZS children had longer hospital stays, ranging from 16.0 to 19.9 days compared to 6.0 to 9.3 days for non-CZS children.
- Common causes of hospitalization in CZS children included congenital malformations, neurological, respiratory, and infectious diseases.

## Abstract

•We evaluated almost 2000 children with confirmed or probable CZS and 2.6 million without CZS.•We estimated hospitalization rates, causes, and length of stay for CZS and non-CZS•Rates of hospitalization were 3 to 7 times higher among CZS vs non-CZS.•Increased morbidity in CZS children persisted during the first 4 years of life.

We evaluated almost 2000 children with confirmed or probable CZS and 2.6 million without CZS.

We estimated hospitalization rates, causes, and length of stay for CZS and non-CZS

Rates of hospitalization were 3 to 7 times higher among CZS vs non-CZS.

Increased morbidity in CZS children persisted during the first 4 years of life.

Congenital Zika Syndrome (CZS) has been linked to a wide spectrum of abnormalities. However, differences in hospitalization patterns between children with and without CZS have not yet been investigated.

We compared rates of hospital admissions for all and specific diseases, proportions of admission causes, and total length of hospital stay (LOS) between children with CZS and those without the syndrome. Adjusted incidence rate ratios (aIRR) and aLOS were estimated using negative binomial regression.

Compared to those without CZS, the aIRR for all-cause hospitalizations in the CZS group ranged from 3.77 (95%CI: 3.47-4.06) in the neonatal period to 7.76 (95%CI: 6.91-8.61) at ages 2-4 years. Similar trends were observed for specific causes of admissions. Most admissions in the CZS group related to congenital malformations, neurological, respiratory and infectious diseases. aLOS ranged from 16.0 days [95%CI: 13.2-19.5] to 19.9 days among CZS patients and 6.0 days [95%CI: 5.9-6.2] to 9.3 days [95%CI: 9.3-9.4] for patients without the syndrome.

Children born with CZS face significantly higher rates of hospitalization and longer stays compared to those without the syndrome during early childhood.