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A prospective cohort study of head circumference and its association with neurodevelopmental outcomes in infants and young children in rural Guatemala

Published online by Cambridge University Press:  22 April 2022

Amy K. Connery Open the ORCID record for Amy K. Connery [Opens in a new window] ,
Molly M. Lamb ,
Alison M. Colbert ,
Desirée Bauer ,
Daniel Olson ,
Alejandra Paniagua-Avila ,
Mirella Calvimontes ,
Guillermo Antonio Bolaños ,
Hana M. El Sahly  and
Flor M. Muñoz
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Amy K. Connery*
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
Molly M. Lamb
Affiliation:
Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
Alison M. Colbert
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
Desirée Bauer
Affiliation:
Center for Human Development, Fundación Para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
Daniel Olson
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Alejandra Paniagua-Avila
Affiliation:
Center for Human Development, Fundación Para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
Mirella Calvimontes
Affiliation:
Center for Human Development, Fundación Para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
Guillermo Antonio Bolaños
Affiliation:
Center for Human Development, Fundación Para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
Hana M. El Sahly
Affiliation:
Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
Flor M. Muñoz
Affiliation:
Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Edwin J. Asturias
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
*
Address for correspondence: Amy K. Connery, Children’s Hospital Colorado, Aurora, CO, USA. Email: [email protected]
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Abstract

Microcephaly, an anthropometric marker of reduced brain volume and predictor of developmental disability, is rare in high-income countries. Recent reports show the prevalence of microcephaly to be much higher in lower resource settings. We calculated the prevalence of microcephaly in infants and young children (n = 642; age range = 0.1–35.9 months), examined trends in occipitofrontal circumference (OFC) growth in the year after birth and evaluated the relationship between OFC and performance on the Mullen Scales of Early Learning (MSEL) in rural Guatemala. Multivariable regression analyses adjusted for age were performed: (1) a model comparing concurrent MSEL performance and OFC at all visits per child, (2) concurrent OFC and MSEL performance by age group, and (3) OFC at enrollment and MSEL at final visit by age group. Prevalence of microcephaly ranged from 10.1% to 25.0%. OFC z-score decreased for most infants throughout the first year after birth. A significant positive association between continuous OFC measurement and MSEL score suggested that children with smaller OFC may do worse on ND tests conducted both concurrently and ∼1 year later. Results were variable when analyzed by OFC cutoff scores and stratified by 6-month age groups. OFC should be considered for inclusion in developmental screening assessments at the individual and population level, especially when performance-based testing is not feasible.

Keywords

Assessmenthead circumferencelow resource settingsneurodevelopmentyoung children
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 13 , Issue 6 , December 2022 , pp. 779 - 786
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Copyright
© The Author(s), 2022. Published by Cambridge University Press in association with International Society for Developmental Origins of Health and Disease

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Footnotes

*

Co-first authors

†

Co-senior authors

References

Ivanovic, DM, Leiva, BP, Pérez, HT, et al. Head size and intelligence, learning, nutritional status and brain development: head, IQ, learning, nutrition and brain. Neuropsychologia. 2004; 42(8), 1118–1131. DOI 10.1016/j.neuropsychologia.2003.11.022.CrossRefGoogle ScholarPubMed
Gale, CR, O’Callaghan, FJ, Godfrey, KM, Law, CM, Martyn, CN. Critical periods of brain growth and cognitive function in children. Brain. 2004; 127(2), 321–329. DOI 10.1093/brain/awh034.CrossRefGoogle ScholarPubMed
Gale, CR, O’Callaghan, FJ, Bredow, M, Martyn, CN. The influence of head growth in fetal life, infancy, and childhood on intelligence at the ages of 4 and 8 years. Pediatrics. 2006; 118(4), 1486–1492. DOI 10.1542/peds.2005-2629.CrossRefGoogle ScholarPubMed
Reiss, AL, Abrams, MT, Singer, HS, Ross, JL, Denckla, MB. Brain development, gender and IQ in children. A volumetric imaging study. Brain. 1996; 119(5), 1763–1774. DOI 10.1093/brain/119.5.1763.CrossRefGoogle ScholarPubMed
Von der Hagen, M, Pivarcsi, M, Liebe, J, et al. Diagnostic approach to microcephaly in childhood: a two-center study and review of the literature. Dev Med Child Neurol. 2014; 56(8), 732–741. DOI 10.1111/dmcn.12425.CrossRefGoogle ScholarPubMed
Abuelo, D. Microcephaly syndromes. Semin Pediatr Neurol. 2007; 14(3), 118–127. DOI 10.1016/j.spen.2007.07.003.CrossRefGoogle ScholarPubMed
Stoler-Poria, S, Lev, D, Schweiger, A, Lerman-Sagie, T, Malinger, G. Developmental outcome of isolated fetal microcephaly. Ultrasound Obstet Gynecol. 2010; 36(2), 154–158. DOI 10.1002/uog.7556.CrossRefGoogle ScholarPubMed
DeSilva, M, Munoz, FM, Sell, E, et al. Congenital microcephaly: case definition & guidelines for data collection, analysis, and presentation of safety data after maternal immunisation. Vaccine. 2017; 35(48), 6472. DOI 10.1016/j.vaccine.2017.01.044.CrossRefGoogle ScholarPubMed
Graham, KA, Fox, DJ, Talati, A, et al. Prevalence and clinical attributes of congenital microcephaly— New York, 2013-2015. Morb Mortal Wkly Rep. 2017; 125. DOI 10.15585/mmwr.mm6605a1.CrossRefGoogle ScholarPubMed
Hoyt, AT, Canfield, MA, Langlois, PH, et al. Pre-Zika descriptive epidemiology of microcephaly in Texas, 2008-2012. Birth Defects Res. 2018; 110(5), 395–405. DOI 10.1002/bdr2.1164.CrossRefGoogle ScholarPubMed
Morris, JK, Rankin, J, Garne, E, et al. Prevalence of microcephaly in Europe: population based study. BMJ. 2016; 354, i4721. DOI 10.1136/bmj.i4721.CrossRefGoogle ScholarPubMed
Rick, AM, Domek, G, Cunningham, M, et al. High background congenital microcephaly in rural Guatemala: implications for neonatal congenital Zika virus infection screening. Glob Heal Sci Pract. 2017; 5(4), 686–696. DOI 10.9745/GHSP-D-17-00116.CrossRefGoogle ScholarPubMed
Victora, CG, Schuler-Faccini, L, Matijasevich, A, Ribeiro, E, Pessoa, A, Barros, FC. Microcephaly in Brazil: how to interpret reported numbers? Lancet. 2016; 387(10019), 621–624. DOI 10.1016/S0140-6736(16)00273-7.CrossRefGoogle ScholarPubMed
Silva, AA, Barbieri, MA, Alves, MT, et al. Prevalence and risk factors for microcephaly at birth in Brazil in 2010. Pediatrics. 2010; 141(2). DOI 10.1542/peds.2017-0589.Google Scholar
Sindhu, KN, Ramamurthy, P, Ramanujam, K, et al. Low head circumference during early childhood and its predictors in a semi-urban settlement of Vellore, Southern India. BMC Pediatr. 2019; 19(1), 142. DOI 10.1186/s12887-019-1553-0.CrossRefGoogle Scholar
Miller, LC, Joshi, N, Lohani, M, et al. Head growth of undernourished children in rural Nepal: association with demographics, health and diet. Paediatr Int Child Health. 2016; 36(2), 91–101. DOI 10.1080/20469047.2015.1133517.CrossRefGoogle ScholarPubMed
Natale, V, Rajagopalan, A. Worldwide variation in human growth and the World Health Organization growth standards: a systematic review. BMJ Open. 2014; 4(1), e003735. DOI 10.1136/bmjopen-2013-003735.CrossRefGoogle ScholarPubMed
Hanley, GE, Janssen, PA. Ethnicity-specific growth distributions for prediction of newborn morbidity. J Obstet Gynaecol Canada. 2012; 34(9), 826–829. DOI 10.1016/S1701-2163(16)35380-4.CrossRefGoogle ScholarPubMed
Madan, A, Holland, S, Humbert, JE, Benitz, WE. Racial differences in birth weight of term infants in a northern California population. J Perinatol. 2002; 22(3), 230–235. DOI 10.1038/sj.jp.7210703.CrossRefGoogle Scholar
Daymont, C, Hwang, WT, Feudtner, C, Rubin, D. Head-circumference distribution in a large primary care network differs from CDC and WHO curves. Pediatrics. 2010; 126(4), e836–e842. DOI 10.1542/peds.2010-0410.CrossRefGoogle Scholar
De Onis, M. Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Int J Paediatr. 2006; 95(Suppl), 450. DOI 10.1080/08035250500323756.Google Scholar
Manandhar, K, Manandhar, DS, Baral, MR. One year follow up study of term babies born at Kathmandu Medical College Teaching Hospital. Kathmandu Univ Med J. 2004; 4(8), 286–290.Google Scholar
Scharf, RJ, Rogawski, ET, Murray-Kolb, LE, et al. Early childhood growth and cognitive outcomes: findings from the MAL-ED study. Matern Child Nutr. 2018; 14(3), 828. DOI 10.1111/mcn.12584.CrossRefGoogle ScholarPubMed
Ivanovic, DM, Leiva, BP, Pérez, HT, et al. Nutritional status, brain development and scholastic achievement of Chilean high-school graduates from high and low intellectual quotient and socio-economic status. Br J Nutr. 2002; 87(1), 81–92. DOI 10.1079/bjn2001485.CrossRefGoogle ScholarPubMed
Olson, D, Lamb, MM, Lopez, MR, et al. A rapid epidemiological tool to measure the burden of norovirus infection and disease in resource-limited settings. Open Forum Infect Dis. 2017; 4(2), e0142927. DOI 10.1093/ofid/ofx049.CrossRefGoogle ScholarPubMed
Asturias, EJ, Heinrichs, G, Domek, G, et al. The Center for Human Development in Guatemala: an innovative model for global population health. Adv Pediatr. 2015; 63(1), 357–387.Google Scholar
Mullen, EM. Mullen Scales of Early Learning, 1995. Pearson, Bloomington, MN.Google Scholar
Colbert, AM, Lamb, MM, Asturias, EJ, et al. Reliability and validity of an adapted and translated version of the mullen scales of early learning (AT-MSEL) in rural Guatemala. Child Care Health Dev. 2020; 46(3), 327–335. DOI 10.1111/cch.12748.CrossRefGoogle Scholar
Connery, AK, Colbert, AM, Lamb, MM, et al. Receptive language skills among young children in rural Guatemala: the relationship between the Test de Vocabulario en Imagenes Peabody and a translated and adapted version of the mullen scales of early learning. Child Care Health Dev. 2019; 45(5), 702–708. DOI 10.1111/cch.12702.CrossRefGoogle Scholar
Connery, A, Berrios-Siervo, G, Arroyave, P, et al. Responding to the Zika Epidemic: preparation of a neurodevelopmental testing protocol to evaluate young children in rural Guatemala. Am J Trop Med Hyg. 2018; 100(2), tpmd180713. DOI 10.4269/ajtmh.18-0713.Google Scholar
World Health Organization. WHO Child Growth Standards: Head Circumference-for-Age, Arm Circumference-for-Age, Triceps Skinfold-for-Age and Subscapular Skinfold-for-Age: Methods and Development, 2007. World Health Organization.Google Scholar
Grantham-McGregor, SM, Fernald, LC, Sethuraman, K. Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life part 1: low birthweight, breastfeeding, and proteinenergy malnutrition. Food Nutr Bull. 1999; 20(1), 53–75. DOI 10.1177/156482659902000107.CrossRefGoogle Scholar
Grembi, JA, Lin, A, Karim, MA, et al. Effect of water, sanitation, handwashing, and nutrition interventions on enteropathogens in children 14 months old: a cluster-randomized controlled trial in rural Bangladesh. J Infect Dis. 2020; 18, 1211. DOI 10.1093/infdis/jiaa549.Google Scholar
Vaidya, A, Saville, N, Shrestha, BP, de L Costello, AM, Manandhar, DS, Osrin, D. Effects of antenatal multiple micronutrient supplementation on children’s weight and size at 2 years of age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet. 2008; 371(9611), 492–499. DOI 10.1016/S0140-6736(08)60172-5.CrossRefGoogle ScholarPubMed
Surkan, PJ, Shankar, M, Katz, J, et al. Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial. Eur J Clin Nutr. 2012; 66(7), 836–842. DOI 10.1038/ejcn.2012.42.CrossRefGoogle ScholarPubMed
Stoch, MB, Smythe, PM. 15-year developmental study on effects of severe undernutrition during infancy on subsequent physical growth and intellectual functioning. Arch Dis Child. 1976; 51(5), 327–336. DOI 10.1136/adc.51.5.327.CrossRefGoogle Scholar
Waterlow, JC. Classification and definition of Protein-Calorie malnutrition. Br Med J. 1972; 3(5826), 566–569. DOI 10.1136/bmj.3.5826.566.CrossRefGoogle ScholarPubMed
Colombo, M, de la Parra, A, López, I. Intellectual and physical outcome of children undernourished in early life is influenced by later environmental conditions. Dev Med Child Neurol. 1992; 34(7), 611–622. DOI 10.1111/j.1469-8749.1992.tb11492.x.CrossRefGoogle ScholarPubMed
Ivanovic, DM, Leiva, BP, Perez, HT, et al. Long-term effects of severe undernutrition during the first year of life on brain development and learning in Chilean high-school graduates. Nutrition. 2000; 16(11-12), 1056–1063. DOI 10.1016/S0899-9007(00)00431-7.CrossRefGoogle ScholarPubMed