Kristina May Joyal, Sorcha Collins, Amber Miners, Nick Barrowman, Ewa Sucha, Jean Allen, Sharon Edmunds, Amy Caughey, Michelle Doucette, Selina Khatun, Gwen Healey Akearok, Laura Arbour, Sunita Venkateswaran
{"title":"加拿大努纳武特地区因纽特人儿童的头围数值:一项回顾性队列研究。","authors":"Kristina May Joyal, Sorcha Collins, Amber Miners, Nick Barrowman, Ewa Sucha, Jean Allen, Sharon Edmunds, Amy Caughey, Michelle Doucette, Selina Khatun, Gwen Healey Akearok, Laura Arbour, Sunita Venkateswaran","doi":"10.1503/cmaj.230905","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts.</p><p><strong>Methods: </strong>We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model.</p><p><strong>Results: </strong>We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most <i>z</i> scores for head circumference measurements among Inuit children falling 0.5-1 standard deviations above the WHO reference (<i>p</i> < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (<i>p</i> < 0.001).</p><p><strong>Interpretation: </strong>Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498335/pdf/","citationCount":"0","resultStr":"{\"title\":\"Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study.\",\"authors\":\"Kristina May Joyal, Sorcha Collins, Amber Miners, Nick Barrowman, Ewa Sucha, Jean Allen, Sharon Edmunds, Amy Caughey, Michelle Doucette, Selina Khatun, Gwen Healey Akearok, Laura Arbour, Sunita Venkateswaran\",\"doi\":\"10.1503/cmaj.230905\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts.</p><p><strong>Methods: </strong>We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model.</p><p><strong>Results: </strong>We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most <i>z</i> scores for head circumference measurements among Inuit children falling 0.5-1 standard deviations above the WHO reference (<i>p</i> < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (<i>p</i> < 0.001).</p><p><strong>Interpretation: </strong>Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.</p>\",\"PeriodicalId\":9609,\"journal\":{\"name\":\"Canadian Medical Association journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.4000,\"publicationDate\":\"2024-10-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498335/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Medical Association journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1503/cmaj.230905\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Medical Association journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1503/cmaj.230905","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study.
Background: Inuit children from Nunavut have been observed to have high rates of macrocephaly, which sometimes leads to burdensome travel for medical evaluation, often with no pathology identified upon assessment. Given reports that World Health Organization (WHO) growth charts may not reflect all populations, we sought to compare head circumference measurements in a cohort of Inuit children with the WHO charts.
Methods: We extracted head circumference data from a previous retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children (from birth to age 5 yr) born between Jan. 1, 2010, and Dec. 31, 2013, and residing in Nunavut. To create a cohort of Inuit children similar to the cohorts used in the development of the WHO growth charts, we excluded children with preterm birth, documented neurologic or genetic disease, and most congenital anomalies. We compared head circumference values with the 2007 WHO charts using centiles estimated with a generalized additive model.
Results: We analyzed records of 1960 Inuit children (8866 data points), of whom 993 (50.8%) were female. Most data were from ages 0 to 36 months. At all age points, we found that the study cohort had statistically significantly larger head circumferences than WHO medians, with most z scores for head circumference measurements among Inuit children falling 0.5-1 standard deviations above the WHO reference (p < 0.001). At age 12 months, median head circumferences were 1.3 cm and 1.5 cm larger for male and female Inuit children, respectively. Using WHO growth curves, macrocephaly was significantly overdiagnosed and microcephaly was underdiagnosed (p < 0.001).
Interpretation: Our results support the observation that Inuit children from Nunavut have larger head circumferences than other populations, and use of the WHO charts may thus lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population-specific growth curves for Inuit children should be considered to provide timely and appropriate diagnoses of microcephaly and avoid overinvestigation of macrocephaly.
期刊介绍:
CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4.
Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes.
CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.