1
|
Goodwin JW, Hopkins L, Conrad AL. White matter tract integrity in isolated oral clefts: relationship to cognition and reading skills. Child Neuropsychol 2024:1-22. [PMID: 38501945 PMCID: PMC11411015 DOI: 10.1080/09297049.2024.2330725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
Children with isolated cleft of the lip and/or palate (iCL/P) have been shown to be at risk for impaired reading ability. Structural and functional neuroimaging studies have revealed subtle morphological and functional abnormalities correlated to cognition and reading ability. However, the integrity of white matter tracts and their potential relationship to reading performance in iCL/P is under-studied. The purpose of the present study was to evaluate white matter integrity related to cognition and reading skills among participants with and without iCL/P. Data from two cross-sectional, case/control studies with similar neuropsychological batteries and diffusion tensor imaging (DTI) protocols were combined. The final sample included 210 participants (ages 7 to 27 years). Group and sex differences in fractional anisotropy (FA) values were examined between participants with (n = 105) and without (n = 105) iCL/P. Potential associations between FA values and age, cognition, and reading skills were also evaluated separately by group and sex. Sex effects were prominent in association and projection fibers, and effects of cleft status were found in association fibers and cerebellar regions, with isolated associations to reading skills. Findings provide preliminary understanding of microstructural associations to cognitive and reading performance among children, adolescents, and young adults with iCL/P.
Collapse
Affiliation(s)
- Jon Willie Goodwin
- Department of Counseling, Clinical and School Psychology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Lauren Hopkins
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| | - Amy Lynn Conrad
- Stead Family Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
2
|
Bedard T, Lowry RB, Crawford S, Wang TG, Bakal J, Metcalfe A, Harrop AR, Grevers X, Thomas MA. Publicly funded healthcare costs associated with orofacial clefts for children born in Alberta, Canada between 2002 and 2018. Birth Defects Res 2024; 116:e2295. [PMID: 38179866 DOI: 10.1002/bdr2.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Orofacial clefts (OFCs) include cleft palate (CP), cleft lip (CL), and cleft lip with cleft palate (CLP) and require multidisciplinary healthcare services. Alberta, Canada has a publicly funded, universal access healthcare system. This study determined publicly funded healthcare costs for children with an OFC and compared these costs to children without congenital anomalies. METHODS This retrospective population-based cohort analysis used the Alberta Congenital Anomalies Surveillance System to identify children born between 2002 and 2018 with an isolated OFC. They were matched 1:1 to a reference cohort based on sex and year of birth. The study population included 1614 children, from birth to 17 years of age linked to administrative databases to estimate annual inpatient and outpatient costs. Average annual all-cause costs were compared using two-sample independent t tests. RESULTS The mean total cleft-related costs per patient were highest for children with CLP ($74,138 CAD, standard deviation (SD) $43,447 CAD), followed by CP ($53,062 CAD, SD $74,366 CAD), and CL ($35,288 CAD, SD $49,720 CAD). The mean total all-cause costs per child were statistically significantly higher (p < .001) in children with an OFC ($56,305 CAD, SD $57,744 CAD) compared to children without a congenital anomaly ($18,600 CAD, SD $61,300 CAD). CONCLUSIONS Despite public health strategies to mitigate risk factors, the trend for OFCs has remained stable in Alberta, Canada for over 20 years. The costs reported are useful to other jurisdictions for comparison, and to families, healthcare professionals, service planners, and policy makers.
Collapse
Affiliation(s)
- Tanya Bedard
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - R Brian Lowry
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Ting Grace Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - A Robertson Harrop
- Departments of Pediatrics and Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Plastic Surgery, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Xin Grevers
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Mary Ann Thomas
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Kapp-Simon KA, Albert M, Edwards TC, Jones SM, Crilly Bellucci C, Rosenberg J, Patrick DL, Heike CL. Developmental Risk for Infants with Cleft Lip with or Without Cleft Palate Based on Caregiver-Proxy Reports. Cleft Palate Craniofac J 2024:10556656231225304. [PMID: 38196373 PMCID: PMC11231059 DOI: 10.1177/10556656231225304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES (1) Assess caregiver-reported development in infants born with cleft lip ± alveolus (CL ± A) and cleft lip and palate (CLP); (2) determine factors associated with increased developmental risk; and (3) determine consistency of developmental risk before and after surgery for cleft lip. DESIGN Prospective, longitudinal assessment of development. Time (T) 1, prior to lip closure; T2, 2 months post lip closure. SETTING Three US craniofacial teams and online parent support groups. PARTICIPANTS 123 total caregivers (96% mothers); 100 at T1, 92 at T2, and 69 at both T1 and T2. MEASURE Ages and Stages Questionnaire-3 (ASQ-3): Communication, Gross Motor, Fine Motor, Problem Solving, Personal Social Domains. RESULTS At T1 47%; at T2 42% passed all 5 Domains; 36% of infants pass all 5 Domains at both T1 and T2. Infants with CLP were at greatest risk on Communication [B = 1.449 (CI = .149-20.079), p = .038; Odds Ratio (OR) = 4.3 (CI = .923-19.650)] and Gross Motor Domains [B = 1.753 (CI = .316-20.605), p = .034; OR = 5.8 (CI = 1.162-28.671)]. Male infants were at greatest risk on Fine Motor [B = 1.542 (CI = .495-20.005), p = .009; OR = 4.7 (CI = 1.278-17.101)] and Problem Solving Domains [B = 1.200 (CI = .118-19.708), p = .044; OR = 3.3 (CI = .896-12.285)]. CONCLUSIONS Based on caregiver report, infants with CL ± A and CLP meet referral criteria at a high rate. Infants with CLP and male infants were at greatest risk. Regular developmental screening is recommended.
Collapse
Affiliation(s)
- Kathleen A Kapp-Simon
- Cleft/Craniofacial Center, Shriners Children's, Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Meredith Albert
- Cleft/Craniofacial Center, Shriners Children's, Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Todd C Edwards
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Janine Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Carrie L Heike
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| |
Collapse
|
4
|
Li Z, Li C, Liang Y, Wang K, Wang L, Zhang X, Wu Q. Anomalous cerebral morphology of pregnant women with cleft fetuses. Front Hum Neurosci 2022; 16:959710. [PMID: 36158614 PMCID: PMC9491019 DOI: 10.3389/fnhum.2022.959710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePregnancy leads to long-lasting changes in brain structure for healthy women; however, little is known regarding alterations in the cortical features of pregnant women with malformed fetuses. Isolated clefts of the lip and/or palate (ICL/P) are the most common congenital anomaly in the craniofacial region, which is highly gene-associated. We speculated that pregnant women carrying fetuses with ICL/P may have associated risk genes and specific brain changes during pregnancy.MethodsIn this study, we investigated T1-weighted brain magnetic resonance imaging data from 48 pregnant women: 24 women carrying fetuses with ICL/P (ICL/P group) and 24 women carrying normal fetuses (normal controls), then explored intergroup differences in gray matter volume (GMV), cortical thickness (CT) and cortical complexity (gyrification).ResultsCompared with controls, the ICL/P group had decreased total intracranial volume (TIV) than normal controls; besides, they exhibited increased GMV in the left cuneus, decreased GMV in the right superior temporal gyrus; increased CT in the left precuneus and left superior parietal gyrus, decreased CT involving parsopercularis, fusiform, middle temporal in the left hemisphere and supramarginal, precentral gyrus (PreCG) in the right hemisphere; increased gyrification in the left insula and PreCG, the left middle temporal, and the right supratemporal gyrus.ConclusionPregnant women with ICL/P fetuses had brain morphology changes involving language, auditory, vision, and sensory cortex, which may be their special brain changes compared to normal pregnant women. This study may provide clues for the early detection of fetuses with ICL/P, and be vital for preconception and prenatal counseling with non-invasive methods.
Collapse
Affiliation(s)
- Zhen Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chunlin Li
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yuting Liang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Keyang Wang
- Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Li Wang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xu Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- *Correspondence: Xu Zhang,
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- Qingqing Wu,
| |
Collapse
|
5
|
Kuhlmann E, van der Plas E, Axelson E, Conrad AL. Brain Developmental Trajectories in Children and Young Adults with Isolated Cleft Lip and/or Cleft Palate. Dev Neuropsychol 2021; 46:314-326. [PMID: 34348063 DOI: 10.1080/87565641.2021.1946691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study evaluated brain development in persons with isolated cleft lip and/or cleft palate (iCL/P) compared to unaffected controls using an accelerated longitudinal design. A sample of 134 males and females, ages 7-27 years, with iCL/P (184 observations, total) was compared to 144 unaffected controls (208 evaluations, total) on Wechsler Index scores and volumetric data from structural MRI scans. Boys with isolated cleft palate had verbal IQ 15.5 points lower than perceptual IQ; a clinically significant difference. Participants with iCL/P had differential growth trajectories of regional cerebrum matter and consistently lower volumes of cerebellar gray matter and subcortical matter.
Collapse
Affiliation(s)
- Emily Kuhlmann
- Department of Psychological and Quantitative Foundations, University of Iowa College of Education, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Carver College of Medicine, USA
| | - Eric Axelson
- Department of Psychiatry, University of Iowa Carver College of Medicine, USA
| | - Amy L Conrad
- The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, USA
| |
Collapse
|