The impact of nutritional status and longitudinal recovery of motor and cognitive milestones in internationally adopted children

A national registry-based study of surgery and demography comparing internationally adopted and children born in Sweden with cleft lip and/or palate

This national registry-based study compares surgical procedures, demography, and concurrent medical conditions, in internationally adopted and Swedish-born children with cleft lip and/or palate until the age of five years. Data on the cleft type and gender for 331 internationally adopted children and 2064 Swedish-born children born from 2007 to 2018, were extracted from the registry and analyzed. Data on surgical procedures performed in Sweden and concurrent medical conditions and were collected for internationally adopted children and Swedish-born children with unilateral or bilateral cleft, born 2007-2013. A higher prevalence of unilateral and bilateral clefts (p < 0.0001), as well as a predominance of male patients with unilateral clefts (p = 0.0025), were identified among the internationally adopted children compared with children born in Sweden. Differences in the concurrence of other medical conditions in internationally adopted children versus Swedish-born infants were non-significant. Primary palatal surgeries performed in Sweden were significantly delayed for the adopted group. More secondary palatal surgeries such as speech improving surgery and palatal re-repair were needed for internationally adopted children (p < 0.0001) until age five.Conclusions: The Swedish CLP Registry provided national coverage of the CL/P cohort. Internationally adopted children exhibited a predominance of more severe cleft types, a predominance of males, delayed primary palatal surgery and increased need for secondary surgeries before age five.

Brain Differences in Adolescents Living With Perinatally Acquired HIV Compared With Adoption Status Matched Controls: A Cross-sectional Study

BACKGROUND AND OBJECTIVES

Despite effective combination antiretroviral therapy (cART), adolescents with perinatally acquired HIV (PHIV) exhibit cognitive impairment, of which structural changes could be the underlying pathophysiologic mechanism. Prior MRI studies found lower brain volumes, higher white matter (WM) hyperintensity (WMH) volume, lower WM integrity, and differences in cerebral blood flow (CBF). However, these findings may be confounded by adoption status, as a large portion of adolescents with PHIV have been adopted. Adoption has been associated with malnutrition and neglect, which, in turn, may have affected brain development. We investigated the long-term effects of PHIV on the brain, while minimizing the confounding effect of adoption status.

METHODS

We determined whole-brain gray matter (GM) and WM volume with 3D T1-weighted scans; total WMH volume with fluid-attenuated inversion recovery; CBF in the following regions of interest (ROIs): WM, GM, and subcortical GM with arterial spin labeling; and whole-brain WM microstructural markers: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) with diffusion tensor imaging in cART-treated adolescents with PHIV visiting our outpatient clinic in Amsterdam and controls matched for age, sex, ethnic origin, socioeconomic status, and adoption status. We assessed differences in neuroimaging parameters between adolescents with PHIV and controls using linear regression models adjusted for age and sex and applied multiple comparison correction.

RESULTS

Thirty-five adolescents with PHIV and 38 controls were included with a median age of 14.9 (interquartile range [IQR]: 10.7-18.5) and 15.6 (IQR: 11.1-17.6) years, respectively, with a similar rate of adoption. We found a lower overall FA (beta = -0.012; p < 0.014, -2.4%), a higher MD (beta = 0.014, p = 0.014, 1.3%), and a higher RD (beta = 0.02, p = 0.014, 3.3%) in adolescents with PHIV vs adoption-matched controls, but no differences in AD. We found comparable GM, WM, and WMH volume and CBF in ROIs between adolescents with PHIV and controls. We did not find an association between cognitive profiles and WM microstructural markers in adolescents with PHIV.

DISCUSSION

Irrespective of adoption status, adolescents with PHIV exhibited subtle lower WM integrity. Our findings may point toward early-acquired WM microstructural alterations associated with HIV.

Quality of Life of Adopted Chinese Versus Nonadopted Dutch Children with Cleft Lip and/or Palate: A Propensity Score Matched Analysis

Objective

To examine quality of life in internationally adopted children with cleft lip and/or palate (CL/P) versus non-adopted children with CL/P.

Design

Cross sectional study.

Setting

Multidisciplinary cleft team of a secondary and tertiary hospital in the Netherlands.

Methods

Parents of children under the age of 8 treated by the multidisciplinary cleft team of our institutions were asked to fill out a questionnaire containing demographic and clinical data and a validated parent proxy measure of cleft-specific quality of life instrument for children aged 0–8: the CleftChild-8. Adopted children were matched to non-adopted children using propensity score matching based on sex, age, type of cleft, if palatal surgery was completed and the level of education of the parent. CleftChild-8 scores were then compared between the matched samples of adopted and non-adopted children with CL/P.

Main Outcome Measure(s)

Differences in (sub)domain scores of the CleftChild-8.

Results

Most median CleftChild-8 scores of the adopted children (n = 29) were slightly lower compared to the 29 matched non-adopted children. A significant difference was seen for the domain score ‘satisfaction with (operative) treatment’ and 3 of the 13 subdomain scores: ‘post-operative results’, ‘acceptance by siblings’ and ‘acceptance by family/friends’.

Conclusions

By parent report, adopted children with CL/P experienced some areas of lower quality of life when compared to non-adopted children. Members of cleft teams should be aware of the problems associated with adoption and offer additional guidance and counseling to adopted children and their parents.

The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review

Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from -2.04 to -0.31 for weight for age; -0.94 to 0.39 for weight for height; -0.7 to 0 for body mass index; -1.89 to -0.03 for height for age; -1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from -0.59 to 0.53 for weight for age; -0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; -1.09 to 0.58 for height for age; -0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.

Beyond Their HIV Status: the Occurrence of Multiple Health Risk Behavior Among Adolescents from a Rural Setting of Sub-Saharan Africa

Background

Health risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role.

Method

In a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified.

Results

No significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective.

Conclusion

The results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.

Investigating the causal relationship between maltreatment and cognition in children: A systematic review

BACKGROUND

Cognitive impairment (i.e. lower IQ/cognitive development) in individuals who have experienced childhood maltreatment is well documented in the literature. It is not yet clear whether maltreatment itself causes cognitive impairment, or whether reduced cognitive functioning pre-dates maltreatment exposure and places children at risk of maltreatment.

OBJECTIVE

This systematic review critically evaluated the evidence for a causal association between child maltreatment and impaired cognition in children under 12 years.

METHODS

Following PRISMA guidelines, databases were searched and articles extracted according to inclusion criteria. Quality rating of articles was conducted independently by two reviewers and the evidence for a causal association was evaluated using guidelines based on the Hill criteria for causation in epidemiological and public health research.

RESULTS

31 articles were included in the review, with results that suggested lower IQ/cognitive development in maltreated children compared to controls, and a dose-response relationship between timing and duration of maltreatment and impaired cognition. Assessment of causality indicated strong evidence for a causal association between maltreatment and reduced overall cognitive performance in institutionalised children. Findings were less robust for non-institutionalised samples. Evidence regarding specific cognitive functions was mixed.

CONCLUSIONS

Extreme maltreatment may lead to reduced cognitive functioning in children under 12 years. More research is required to determine the impact of the nature and timing of maltreatment, as well as additional heritable and social factors, on specific profiles of cognition in this population.

Assessing and decomposing inequality of opportunity in access to child health and nutrition in sub-Saharan Africa: evidence from three countries with low human development index

Background

Inequality of opportunity in health and nutrition is a major public health issue in the developing regions. This study analyzed the patterns and extent of inequality of opportunity in health and nutrition among children under-five across three countries sub-Saharan Africa with low Human development index (HDI).

Methods

We used data from the Multiple Indicator Cluster Survey of the Democratic Republic of Congo (20,792 households, 21,756 women aged 15 to 49 and 21,456 children under five), Guinea Bissau (6601 households, 10,234 women aged 15–49 and 7573 children under five) and Mali (11,830 households, 18,409 women in 15–49 years and 16,468 children under five) to compute the human opportunity index (HOI) and the dissimilarity index (D-index). Secondly, the Shapley decomposition method was used to estimate the relative contribution of circumstances that are beyond the control of children under-five and affecting their development outcomes in later life stages.

Results

The study revealed that children belonging to the most favorable group had higher access rates for immunization (93.64%) and water and sanitation facilities (73.59%) in Guinea Bissau. In Congo DR, the access rate was high for immunization (93.9%) for children in the most favorable group. In Mali, access rates stood at 6.56% for children in the most favorable group. In Guinea Bissau, the inequality of opportunity was important in access to health services before and after delivery (43.85%). In Congo DR, the inequality of opportunity was only high for the immunization composite indicator (83.79%) while in Mali, inequality of opportunity was higher for access to health services before and after delivery (41.67%).

Conclusion

The results show that there are efforts in some places to promote access to health and nutrition services in order to make access equal without distinction linked to the socio-economic and demographic characteristics in which the children live. However, the inequalities of opportunity observed between the children of the most favorable group and those of the least favorable group, remain in general at significant levels and call on government of these countries to implement policies taking them into account.

Factors associated with malnutrition in children < 5 years in western Kenya: a hospital-based unmatched case control study

BACKGROUND

Globally, under-nutrition accounts for > 3 million deaths annually among children < 5 years, with Kenya having ~ 35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya.

METHODS

We conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height ≤ -2SD or ≥ +2SD; weight-for-age ≤ -2SD or ≥ +2SD; or height-for-age ≤ -2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses.

RESULTS

A total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR = 7.9; 95% CI: 1.5-41.2), deworming (OR = 0.8; 95% CI: 0.4-1.2), and pre-lacteal feeding (OR = 1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR = 13.9; 95% CI: 2.8-68.6); low birth weight (AOR = 3.3; 95% CI: 1.4-7.6), and paternal lack of formal education (AOR = 4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition.

CONCLUSION

Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

Health status and nutritional development of adopted Ethiopian children living in southern Spain: A prospective cohort study

OBJECTIVE

The first aim of this study was to evaluate the health status and anthropometrical development of adopted children from Ethiopia living in southern Spain. A second aim was to evaluate the association between these parameters and adherence to the Mediterranean dietary pattern.

METHODS

The study sample included 53 adopted children from Ethiopia and a matched sample of 54 native-born children. A physical examination of the children, including height and weight, was conducted in Ethiopia at the time of entry into the adoption process. Height and weight were re-measured at the first day of adoption and 6, 12, and 24 mo after adoption. After 2 y of follow-up, another physical examination was performed, including the KIDMED test, to measure adherence to the Mediterranean diet.

RESULTS

Skin and digestive conditions were the most prevalent disorders in Ethiopian children before adoption and at the end of follow-up. Baseline anthropometric characteristics indicated a low wasting prevalence (7.5%); however, stunted growth was more prevalent (35.8%). After 6 mo, the weight-for-age of Ethiopian children was restored (change from baseline P < 0.001), and not significantly different from the Spanish children at 1-y after adoption. Height-for-age also increased from baseline (P < 0.001. A higher KIDMED score was associated with increased weight-for-age (r = 0.279; P = 0.045) and height-for-age (r = 0.385; P = 0.004).

CONCLUSIONS

This prospective study of adopted Ethiopian children confirmed a rapid growth development that occurred from the beginning of the adoption process and continued after the 2-y of follow-up. A higher adherence to the Mediterranean diet was associated with better growth development, which reinforces the importance of a balanced and adequate diet in growing children.

A New Approach to Comprehensive Growth and Nutrition Assessment in Children

A new approach to comprehensive growth and nutrition assessment of infants, children, and adolescents that is etiology based and relatively simple to implement is now available. It encompasses five domains: anthropometry (growth measurements), assessment of change in growth (growth dynamism), duration of the growth abnormalities, etiology of the nutritional imbalance, and impact of the nutritional state on functional outcomes. Its increased use will help to standardize the screening, diagnosis, and documentation of malnutrition in both ambulatory and hospitalized patients. [Pediatr Ann. 2019;48(11):e425-e433.].

Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development

OBJECTIVE

Children in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children.

METHOD

Relevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies.

RESULTS

Two key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition.

CONCLUSION

Attention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.

Nutritional and Immunological Correlates of Memory and Neurocognitive Development Among HIV-Infected Children Living in Kayunga, Uganda

OBJECTIVE

To identify the nutritional and immunological correlates of memory and neurocognitive development as measured by the Mullen Scales of Early Learning (MSEL) and by the Color Object Association Test (COAT) among children in Uganda.

DESIGN

This analysis uses baseline data collected between 2008 and 2010 from 119 HIV-infected children aged 1-6 years, participating in a randomized controlled trial of an interventional parenting program in Kayunga, Uganda.

METHODS

Peripheral blood draws were performed to determine immunological biomarkers. Unadjusted and adjusted linear regression models were used to relate MSEL and COAT scores to sociodemographic characteristics, weight-for-age Z scores (WAZs), antiretroviral therapy status, and immunological biomarkers.

RESULTS

In the final analysis, 111 children were included. Lower levels of CD4 CD38 T cells (P = 0.04) were associated to higher immediate and total recall scores (P = 0.04). Higher levels of CD8 HLA-DR T cells were associated with higher total recall score (P = 0.04) of the COAT. Higher CD4 CD38 HLA-DR T cells levels were associated with higher gross motor scores of the MSEL (P = 0.02). WAZ was positively correlated to visual reception, fine motor, expressive language, and composite score of the MSEL.

CONCLUSIONS

Overall, WAZ was a stronger predictor of neurocognitive outcomes assessed by the MSEL. CD4 CD38 T cells were more specifically associated with memory-related outcomes. Future research should include immunological markers and standardized neurocognitive tests to further understand this relationship.

CHILD GROWTH: CONCEPT ANALYSIS

ABSTRACT The aim of this study was to analyze the concept of child growth by identifying the attributes and consequences that make up the phenomenon. The concept analysis was supported by 41 studies and based on the evolutionary analysis model and integrative literature review. Five databases, Scopus, CINAHL, LILACS, PubMed, and the Cochrane Library were searched to select articles. The search found that growth has presented different connotations, including social and physiological aspects, which are part of the physical domain of child development. Attributes, antecedents, and consequences identified provide an overview of the phenomenon analyzed, because these point out several aspects previously related to other studies on child growth. The theoretical understanding about child growth can offer nurses in-depth knowledge about factors involved in this process, facilitating intervention-based decision-making.

A refined approach to evaluating global developmental delay for the international medical community

BACKGROUND

Global developmental delay is usually defined as significant delay in two or more domains of development. Etiologic diagnosis generally proves difficult and the etiology remains undetermined in up to 62% of these children. Those in whom an etiology is established generally undergo an exhaustive and costly diagnostic evaluation, even though this may not change the medical or therapeutic management of the delay. The history and physical examination may provide up to 40% of etiologic diagnoses if adequately conducted.

METHODS

We performed a critical review of the literature on global developmental delay via PubMed.

RESULTS

Five major etiologic categories for global developmental delay were identified and traits of the history and physical examination suggestive for their diagnosis were described. Additionally, current diagnostic tools and their benefits and limitations were appraised.

CONCLUSIONS

We propose an improved approach to enhance clinical diagnosis in both resource-rich and resource-limited settings favoring early intervention and management.

Developmental delays at arrival, early intervention enrollment, and adopted Chinese girls' academic performance and internalizing problems in adolescence

The author investigated the extent of developmental delays in girls adopted from China, their subsequent early intervention (EI) enrollment, and how the delays and EI were related to their academic performance and internalizing problems in adolescence. The sample included 180 adolescent girls (M = 13.4 years, SD = 2.0 years) who were adopted at 3-23.5 months (M = 11.5 months, SD = 3.7 months). Data on the adopted Chinese girls' delays at arrival and EI enrollment in physical therapy (PT) and speech-language therapy (SLT) were collected from the adoptive mothers at the Baseline; data on the adopted Chinese girls' present academic performance and internalizing problems were collected from the adoptive mothers and adopted girls at Wave 4 six years later. Data analyses revealed that 55% of the adoptees had moderate-to-severe delays when first arrived at the adoptive homes. Motor delays significantly increased the odds for PT (odds ratio [OR] = 3.98, 95% CI [2.18, 7.82], p <.001) and SLT (OR = 2.36, 95% CI [1.50-3.72, p <.001). Social-cognitive delays also significantly increased the odds for PT (OR = 1.90, 95% CI [1.36, 2.63], p <.001) and SLT (OR = 1.63, 95% CI [1.22, 2.17], p <.001). Motor delays were negatively associated with academic performance but positively associated with internalizing problems. General linear modeling showed that the adoptees who had developmental delays at arrival and subsequently enrolled in EI scored significantly lower on academic performance than their peers who had delays but did not enroll in EI, as well their peers who had no delays and did not enroll in EI. Implications of these findings are discussed.

Prevalence of vitamin D deficiency in international adoptees within the first 6 months after adoption

BACKGROUND

Vitamin D deficiency impairs bone health and development.

OBJECTIVE

To determine the prevalence of and risk factors for vitamin D deficiency in pediatric international adoptees.

METHODS

A prospective cohort (N = 189) study from a single international adoption clinic was conducted. Total 25-hydroxy vitamin D [25(OH)D] level was measured at the initial clinical assessment (within 6 months of adoption). Vitamin D deficiency was defined as a 25(OH)D <20 ng/mL (<8 nmol/L) and insufficiency as 25(OH)D <30 ng/mL (<12 nmol/L).

RESULTS

Vitamin D deficiency was diagnosed in 8% and insufficiency in 27% of the cohort. Lower body mass index and longer time in an institution were associated with vitamin D deficiency and insufficiency independent of age.

CONCLUSIONS

Vitamin D insufficiency was common in our cohort of international adoptees. The significance of vitamin D insufficiency on bone development during the typical "catch-up" growth following international adoption needs to be determined.