Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015.
OBJECTIVE
To assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil.


METHODS
We contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than -3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2.


RESULTS
Between 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2-8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012.


CONCLUSIONS
The numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Juliana Sousa
JS
Soares de Araújo
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Cláudio Teixeira
CT
Regis
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Renata Grigório Silva
RG
Gomes
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Thiago Ribeiro
TR
Tavares
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Cícera
C
Rocha Dos Santos
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Patrícia Melo
PM
Assunção
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Renata Valéria
RV
Nóbrega
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Diana de Fátima Alves
DF
Pinto
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Bruno Vinícius Dantas
BV
Bezerra
The Heart Circle-Royal Portuguese Hospital, Av. Agamenon Magalhães 2760, Paissandu, Recife, Pernambuco, CEP 52010-902, Brazil .
Sandra da Silva
SD
Mattos
D001938:Brazil / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008831:Microcephaly / Q000453:epidemiology*; D012189:Retrospective Studies