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Rahman M, Avila S, Heike CL, Stock NM, Stueckle L, Schefer A, Johns AL. Psychosocial Experiences of Spanish-Speaking Parents of Children With Craniofacial Microsomia. J Craniofac Surg 2024:00001665-990000000-01571. [PMID: 38738891 DOI: 10.1097/scs.0000000000010295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Craniofacial microsomia (CFM) and microtia psychosocial research in the US is primarily with English-speaking participants. Given that 19% of the US is Latino, and there is a higher prevalence of CFM in Latino populations, this study aims to describe psychosocial experiences related to CFM among Spanish-speaking Latino caregivers to better inform health care. Narrative interviews (mean 73±17 min) were completed in Spanish with parents of children with CFM aged 3 to 17 (mean age 10.8±4.8 years). Transcripts were analyzed using quantitative linguistic analyses and reflexive thematic analysis. Participants (N=12) were mostly mothers (83%) who had immigrated to the US and had low socioeconomic status. Based upon analysis of grouped word counts, participants spent approximately half of their narratives discussing the first two years of their child's life. Themes selected based on US Latino sociodemographics and cultural values included the Impact of Language, Healthcare Challenges, Supportive Healthcare Experiences, Caregiver Coping with CFM, Family Roles, and Addressing Social Implications of CFM. Results highlighted that the first years of care are of critical importance to parents and suggest this is an optimal time to focus on education and support services for families. Additional treatment suggestions include providing interpretation and informational materials in Spanish, addressing care barriers, supporting familial and child coping, accounting for the role of extended family, and helping address social concerns. Ongoing research with Latino families can further assist in guiding culturally sensitive CFM health care.
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Affiliation(s)
- Muhammad Rahman
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Sandra Avila
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Laura Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Alexis L Johns
- Children's Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Costa B, Stock NM, Johns AL, McKinney CM, Drake AF, Schefer A, Heike CL. "I can't provide what my child needs": Early feeding experiences of caregivers of children with craniofacial microsomia. J Pediatr Nurs 2024:S0882-5963(24)00178-7. [PMID: 38729894 DOI: 10.1016/j.pedn.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/06/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE Craniofacial microsomia (CFM) is a congenital condition that can be associated with feeding challenges in infants. As part of the larger 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program, this study described caregivers' early feeding experiences. DESIGN AND MATERIALS US-based caregivers of 34 children with CFM participated in remote narrative interviews. Two authors completed inductive thematic analysis in an iterative process until consensus was reached. RESULTS Caregivers' narratives outlined the inherent challenges of feeding an infant with special healthcare needs. The first theme 'Navigating Challenges and Managing Expectations' describes the distress participants experienced when they were unable to breastfeed and the negative emotional effect of switching to formula. The second theme 'Making Adaptations' outlines the methods participants tried, including breast pumps and feeding tubes. The third theme 'Accessing Support' describes participants' interactions with healthcare providers and challenges accessing feeding support. The final theme 'Growing from Adversity' recounts participants' relief once their child established a feeding pattern and the personal growth gained from their experiences. CONCLUSIONS Caregivers reported several feeding related challenges associated with CFM, many of which negatively affected their wellbeing. Negative consequences were particularly pronounced in cases where caregivers' feeding experiences differed from their expectations. Participants identified challenges in accessing reliable feeding information and support. Despite difficult experiences, caregivers cited some positive outcomes, including increased confidence and resilience. PRACTICE IMPLICATIONS Holistic feeding information and support for families affected by CFM should be inclusive of several feeding methods to improve care delivery, child health, and the caregiver experience.
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Affiliation(s)
- Bruna Costa
- Center for Appearance Research, University of the West of England, UK
| | - Nicola M Stock
- Center for Appearance Research, University of the West of England, UK
| | - Alexis L Johns
- Divison of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, USA
| | | | - Amelia F Drake
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Amy Schefer
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Carrie L Heike
- Seattle Children's Research Institute, Seattle, WA, USA.
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Johns AL, McWilliams D, Costa B, Heike CL, Feragen KB, Hotton M, Crerand CE, Drake AF, Schefer A, Tumblin M, Stock NM. Early Experiences of Parents of Children With Craniofacial Microsomia. J Obstet Gynecol Neonatal Nurs 2024; 53:296-307. [PMID: 38320743 PMCID: PMC11081840 DOI: 10.1016/j.jogn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/02/2024] [Accepted: 01/02/2023] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To describe the early health care experiences of parents of children with craniofacial microsomia (CFM), a congenital diagnosis often identified at birth. DESIGN Qualitative descriptive. SETTING Homes of participants. PARTICIPANTS Parents of 28 children with CFM from across the United States. METHODS We interviewed participants (27 mothers individually and one mother and father together) via telephone or teleconference and used reflexive thematic analysis to derive themes that represented early health care experiences of parents of children with CFM. RESULTS Participants' narratives included detailed recounting of their birth and early care experiences. We identified two overarching themes. The first overarching theme, Stressors, included four subthemes that represented difficulties related to emotional reactions and negative experiences with health care providers. The second overarching theme, Finding Strength, included four subthemes that represented participants' positive adjustment to stressors through independent information seeking about CFM, adaptive coping, positive experiences with health care providers, and drawing on external supports. CONCLUSION Participants often described early experiences as challenging. Findings have implications for improving early care, including increasing open and supportive communication by health care professionals, expanding access to CFM information, screening for mental health concerns among parents, strengthening coping among parents, and linking families to resources such as reliable online CFM information and early intervention programs.
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Stock NM, Costa B, Parnell J, Johns AL, Crerand CE, Billaud Feragen K, Stueckle LP, Mills A, Magee L, Hotton M, Tumblin M, Schefer A, Drake AF, Heike CL. A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2024:10556656241245284. [PMID: 38584503 DOI: 10.1177/10556656241245284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. DESIGN Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. RESULTS Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. CONCLUSIONS Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jade Parnell
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura P Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Mills
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leanne Magee
- Buerger Center for Advanced Pediatric Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, England
| | - Melissa Tumblin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel School of Medicine, Chapel Hill, NC, USA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Rosenberg JM, Bellucci CC, Edwards TC, Heike CL, Leroux BG, Jones SM, Stueckle LP, Patrick DL, Albert M, Aspinall CL, Kapp-Simon KA. Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery. Cleft Palate Craniofac J 2024; 61:271-283. [PMID: 36112919 PMCID: PMC11037889 DOI: 10.1177/10556656221125371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings. DESIGN The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations. PARTICIPANTS Caregivers (N = 140) of infants with CL with/without cleft palate. MAIN OUTCOME MEASURES The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression. RESULTS Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001). CONCLUSIONS COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.
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Affiliation(s)
- Janine M Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | | | - Todd C Edwards
- Health Services, University of Washington, Seattle, Washington, USA
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | | | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura P Stueckle
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meredith Albert
- Shriners Hospitals for Children, Chicago Cleft/Craniofacial, Chicago, Illinois, USA
| | | | - Kathleen A Kapp-Simon
- Shriners Hospitals for Children, Cleft/Craniofacial Chicago, Illinois and University of Illinois at Chicago, Chicago, Illinois, USA
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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 DOI: 10.1177/10556656231225304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Opel DJ, Vo HH, Dundas N, Spielvogle H, Mercer A, Wilfond BS, Clark J, Heike CL, Weiss EM, Bryan MA, Shah SK, McCarty CA, Robinson JD, Blumenthal-Barby J, Tilburt J. Validation of a Process for Shared Decision-Making in Pediatrics. Acad Pediatr 2023; 23:1588-1597. [PMID: 36682451 DOI: 10.1016/j.acap.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision-making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach.
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Affiliation(s)
- Douglas J Opel
- Division of Bioethics and Palliative and Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (DJ Opel), Seattle, Wash.
| | - Holly Hoa Vo
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Nicolas Dundas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Heather Spielvogle
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Amanda Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Benjamin S Wilfond
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Jonna Clark
- Division of Critical Care Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (J Clark), Seattle, Wash
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (CL Heike), Seattle, Wash
| | - Elliott M Weiss
- Division of Neonatology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics (EM Weiss), Seattle, Wash
| | - Mersine A Bryan
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (MA Bryan), Seattle, Wash
| | - Seema K Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill
| | - Carolyn A McCarty
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (CA McCarty), Seattle, Wash
| | - Jeffrey D Robinson
- Department of Communication, Portland State University (JD Robinson), Portland, Ore
| | - Jennifer Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex
| | - Jon Tilburt
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz
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Renkema RW, de Vreugt V, Heike CL, Padwa BL, Forrest CR, Dunaway DJ, Wolvius E, Caron CJ, Koudstaal MJ. Evaluation of Research Diagnostic Criteria in Craniofacial Microsomia. J Craniofac Surg 2023; 34:1780-1783. [PMID: 37264504 PMCID: PMC10445631 DOI: 10.1097/scs.0000000000009446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/16/2023] [Indexed: 06/03/2023] Open
Abstract
Characteristics of patients with craniofacial microsomia (CFM) vary in type and severity. The diagnosis is based on phenotypical assessment and no consensus on standardized clinical diagnostic criteria is available. The use of diagnostic criteria could improve research and communication among patients and healthcare professionals. Two sets of phenotypic criteria for research were independently developed and based on multidisciplinary consensus: the FACIAL and ICHOM criteria. This study aimed to assess the sensitivity of both criteria with an existing global multicenter database of patients with CFM and study the characteristics of patients that do not meet the criteria. A total of 730 patients with CFM from were included. Characteristics of the patients were extracted, and severity was graded using the O.M.E.N.S. and Pruzansky-Kaban classification. The sensitivity of the FACIAL and ICHOM was respectively 99.6% and 94.4%. The Cohen's kappa of 0.38 indicated a fair agreement between both criteria. Patients that did not fulfill the FACIAL criteria had facial asymmetry without additional features. It can be concluded that the FACIAL and ICHOM criteria are accurate criteria to describe patients with CFM. Both criteria could be useful for future studies on CFM to create comparable and reproducible outcomes.
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Affiliation(s)
- Ruben W. Renkema
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia’s Children’s Hospital Rotterdam
| | - V. de Vreugt
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia’s Children’s Hospital Rotterdam
| | | | - Bonnie L. Padwa
- The Craniofacial Centre, Boston Children’s Hospital, Boston, MA
| | | | | | - E.B. Wolvius
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia’s Children’s Hospital Rotterdam
| | - Cornelia J.J.M. Caron
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia’s Children’s Hospital Rotterdam
| | - Maarten J. Koudstaal
- The Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia’s Children’s Hospital Rotterdam
- The Craniofacial Centre, Boston Children’s Hospital, Boston, MA
- The Craniofacial Unit, Great Ormond Street Hospital, London, UK
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Stock NM, Crerand CE, Johns AL, McKinney CM, Koudstaal MJ, Drake AF, Heike CL. Establishing an International Interdisciplinary Research Network in Craniofacial Microsomia: The CARE Program. Cleft Palate Craniofac J 2023:10556656231176904. [PMID: 37248561 PMCID: PMC10984877 DOI: 10.1177/10556656231176904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Craniofacial microsomia (CFM) is a broad clinical term used to describe a congenital condition most commonly involving the underdevelopment of the external ear, mandible, soft tissues, and facial nerve. Despite medical advances, understanding of the psychological health and healthcare experiences of individuals with CFM and their caregivers remains limited. This article describes a research program designed to address these knowledge gaps, and identify opportunities for psychosocial intervention and improved healthcare provision. DESIGN The Craniofacial microsomia: Accelerating Research and Education (CARE) research program aims to: 1) Conduct up to 160 narrative interviews with individuals and caregivers to validate a conceptual framework; 2) Administer an online international survey of up to 800 individuals with CFM and caregivers to identify predictors of psychological distress; 3) Perform up to 60 semi-structured interviews with healthcare providers and advocacy leaders to examine the extent to which current healthcare provisions address identified patient needs; and 4) Establish a participant registry to build a longitudinal database and develop an international community. RESULTS Teams in the USA and UK have been established, alongside an international, interdisciplinary Advisory Committee. Data analysis for Aim 1 is ongoing and informing the delivery of Aims 2-3. Aim 4 is also in development. A dedicated website serves as a recruitment tool, educational resource, and mechanism for engaging with the CFM community. CONCLUSIONS The CARE program provides a comprehensive approach to understanding the experiences of individuals with CFM and their caregivers. Challenges encountered and lessons learned are shared for the benefit of the community.
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Affiliation(s)
- Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Canice E. Crerand
- Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, USA 43205
| | - Alexis L. Johns
- Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, USA 90027
| | - Christy M. McKinney
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
| | - Maarten J. Koudstaal
- Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Amelia F. Drake
- University of North Carolina at Chapel School of Medicine, 170 Manning Drive, CB 7070, Chapel Hill, NC, USA 27599
| | - Carrie L. Heike
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
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Rahman M, Leroux BG, McKinney CM, Kapp-Simon KA, Edwards T, Jones SM, Rosenberg JM, Patrick D, Daniels K, Stueckle L, Heike CL. Observations by Caregivers Using the Infant with Clefts Observation Outcomes Instrument (iCOO): A Comparison of Three Versus Seven-day Daily Diaries. Cleft Palate Craniofac J 2023:10556656231175290. [PMID: 37186767 DOI: 10.1177/10556656231175290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Our goal was to compare data collected from 3- and 7-day Infant with Clefts Observation Outcomes (iCOO) diaries. DESIGN Secondary data analysis of an observational longitudinal cohort study. Caregivers completed the daily iCOO for 7 days before cleft lip surgery (T0) and for 7 days after cleft lip repair (T1). We compared 3- and 7-day diaries collected at T0 and 3- and 7-day diaries collected at T1. SETTING United States. PARTICIPANTS Primary caregivers of infants with cleft lip with and without cleft palate (N = 131) planning lip repair and enrolled in original iCOO study. MAIN OUTCOMES MEASURE(S) Mean differences and Pearson correlation coefficients. RESULTS Correlation coefficients were high for global impressions (>0.90) and scaled scores (0.80-0.98). Mean differences were small across iCOO domains at T0. T1 comparisons reflected the same pattern. CONCLUSIONS Three-day diary data is comparable to 7-day diaries for measuring caregiver observations using iCOO across T0 and T1.
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Affiliation(s)
- Muhammad Rahman
- Seattle Children's Hospital, Seattle, WA
- University of Washington, Seattle, WA
| | | | | | | | | | | | | | | | | | | | - Carrie L Heike
- Seattle Children's Hospital, Seattle, WA
- University of Washington, Seattle, WA
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Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2023:10556656231157449. [PMID: 36802967 DOI: 10.1177/10556656231157449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. 7284University of Washington School of Medicine, Seattle, WA, USA
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, 1862Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, 1811Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- 145793Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
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12
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Quiat D, Timberlake AT, Curran JJ, Cunningham ML, McDonough B, Artunduaga MA, DePalma SR, Duenas-Roque MM, Gorham JM, Gustafson JA, Hamdan U, Hing AV, Hurtado-Villa P, Nicolau Y, Osorno G, Pachajoa H, Porras-Hurtado GL, Quintanilla-Dieck L, Serrano L, Tumblin M, Zarante I, Luquetti DV, Eavey RD, Heike CL, Seidman JG, Seidman CE. Damaging variants in FOXI3 cause microtia and craniofacial microsomia. Genet Med 2023; 25:143-150. [PMID: 36260083 PMCID: PMC9885525 DOI: 10.1016/j.gim.2022.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Craniofacial microsomia (CFM) represents a spectrum of craniofacial malformations, ranging from isolated microtia with or without aural atresia to underdevelopment of the mandible, maxilla, orbit, facial soft tissue, and/or facial nerve. The genetic causes of CFM remain largely unknown. METHODS We performed genome sequencing and linkage analysis in patients and families with microtia and CFM of unknown genetic etiology. The functional consequences of damaging missense variants were evaluated through expression of wild-type and mutant proteins in vitro. RESULTS We studied a 5-generation kindred with microtia, identifying a missense variant in FOXI3 (p.Arg236Trp) as the cause of disease (logarithm of the odds = 3.33). We subsequently identified 6 individuals from 3 additional kindreds with microtia-CFM spectrum phenotypes harboring damaging variants in FOXI3, a regulator of ectodermal and neural crest development. Missense variants in the nuclear localization sequence were identified in cases with isolated microtia with aural atresia and found to affect subcellular localization of FOXI3. Loss of function variants were found in patients with microtia and mandibular hypoplasia (CFM), suggesting dosage sensitivity of FOXI3. CONCLUSION Damaging variants in FOXI3 are the second most frequent genetic cause of CFM, causing 1% of all cases, including 13% of familial cases in our cohort.
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Affiliation(s)
- Daniel Quiat
- Department of Cardiology, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA,Department of Genetics, Harvard Medical School, Boston, MA
| | - Andrew T. Timberlake
- Hansjörg Wyss Department of Plastic and Reconstructive Surgery, NYU Langone Medical Center, New York, NY
| | | | - Michael L. Cunningham
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA,Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA
| | | | | | | | | | | | - Jonas A. Gustafson
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | | | - Anne V. Hing
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA,Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA
| | | | | | - Gabriel Osorno
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Harry Pachajoa
- Servicio de Genética Médica, Fundación Valle del Lili, Cali, Colombia,Centro de Investigación en Anomalías Congénitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
| | | | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | | | | | - Ignacio Zarante
- Human Genomics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Daniela V. Luquetti
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA,Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA
| | - Roland D. Eavey
- Department of Otolaryngology–Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN,Correspondence and requests for materials should be addressed to Roland D. Eavey, Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center; Nashville, TN 37232. OR Carrie L. Heike, Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA 98105. OR Jonathan G. Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. OR Christine Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. c
| | - Carrie L. Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA,Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA,Correspondence and requests for materials should be addressed to Roland D. Eavey, Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center; Nashville, TN 37232. OR Carrie L. Heike, Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA 98105. OR Jonathan G. Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. OR Christine Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. c
| | - Jonathan G. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA,Correspondence and requests for materials should be addressed to Roland D. Eavey, Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center; Nashville, TN 37232. OR Carrie L. Heike, Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA 98105. OR Jonathan G. Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. OR Christine Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. c
| | - Christine E. Seidman
- Department of Genetics, Harvard Medical School, Boston, MA,Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA,Howard Hughes Medical Institute, Chevy Chase, MD,Correspondence and requests for materials should be addressed to Roland D. Eavey, Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center; Nashville, TN 37232. OR Carrie L. Heike, Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA 98105. OR Jonathan G. Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. OR Christine Seidman, Department of Genetics, Harvard Medical School, 77 Avenue Louis, Pasteur, Boston, MA 02115. c
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13
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Renkema RW, Caron CJJM, Heike CL, Koudstaal MJ. A decade of clinical research on clinical characteristics, medical treatments, and surgical treatments for individuals with craniofacial microsomia: What have we learned? J Plast Reconstr Aesthet Surg 2022; 75:1781-1792. [PMID: 35365411 DOI: 10.1016/j.bjps.2022.02.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
AIM This article provides a review of a decade of clinical research studies on clinical features, medical interventions, and surgical interventions for individuals with craniofacial microsomia (CFM). We also provide recommendations for future clinical research. METHOD A systematic search of literature was conducted in Embase and PubMed/MEDLINE Ovid. All publications from 2010 to 2020 that included at least 10 individuals with CFM were considered relevant for this study. RESULTS A total of 91 articles were included. In the past decade, many new studies on CFM have been published providing more insight on the diagnosis and management of patients with CFM. This review encompasses findings on the clinical difficulties patients with CFM encounter, including the craniofacial and extracraniofacial characteristics of patients with CFM and its related clinical consequences on breathing, feeding, speech, and hearing. CONCLUSIONS A considerable number of large multicenter studies have been published in recent years, providing new insights in the clinical consequences of CFM. The phenotypic variety between patients with CFM makes patient-specific treatment tailored to individual needs essential. The research and development of clinical care standards might be challenging because of the heterogeneity of CFM. Future research on clinical and patient-reported outcomes can help identify optimal treatment strategies. Cooperation between craniofacial centers, using uniform registration and outcome measurement tools, could enhance research and future care for these patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ruben W Renkema
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland.
| | - Cornelia J J M Caron
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland
| | - Carrie L Heike
- Seattle Children's Craniofacial Center, Seattle, United States
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Center, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, 's Gravendijkwal 230, Rotterdam 3015 CE, the Netherland
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14
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Jones SMW, Edwards TC, Leroux BG, Kapp-Simon KA, Patrick DL, Stueckle LP, Rosenberg JM, Albert M, Bellucci CC, Aspinall CL, Vick K, Heike CL. Exploration of Caregiver Interrater Agreement and Test-Retest Reliability on the Infant Cleft Observer Outcomes (iCOO). Cleft Palate Craniofac J 2022:10556656221089155. [PMID: 35341357 PMCID: PMC9515238 DOI: 10.1177/10556656221089155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caregiver and observer-reported measures are frequently used as outcomes for research on infants and young children who are unable to report on their own health. Our team developed the Infant with Clefts Observation Outcomes Instrument (iCOO) for infants with cleft lip with or without cleft palate. This exploratory study compared test-retest and interrater reliabilities to inform whether differences in caregiver perspective might affect the iCOO. This study is a secondary analysis comparing caregiver interrater agreement to test-retest reliability. Twenty-five pairs of caregivers completed the iCOO before surgery, 1 week later for test-retest reliability, 2 days after surgery, and 2 months after surgery. Reliability was assessed using intraclass correlations (ICCs) and t-tests were used to compare ratings between caregivers. Infants had cleft lip (28%) or cleft lip and palate (72%). Primary caregivers were predominantly mothers (92%) and secondary caregivers were predominantly fathers (80%). Test-retest reliability met psychometric standards for most items on the iCOO (81%-86% of items). Caregiver agreement on the iCOO items was lower than test-retest reliability (33%-46% of items met psychometric standards). Caregivers did not systematically differ in whether they rated infants as healthier or less healthy than the other caregiver (5%-16% of items had statistically significant differences). Caregivers used the measure consistently, but had different experiences and perceptions of their infant's health and functioning. Future studies are needed to explore mechanisms for the differences in test-retest and interrater reliability. Whenever possible, the same caregiver should provide ratings of the infant, including on the iCOO.
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15
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Edwards TC, Heike CL, Kapp-Simon KA, Jones SM, Leroux BG, Stueckle LP, Bellucci CC, Rosenberg JM, Albert M, Aspinall CL, Patrick DL. Infant with Clefts Observation Outcomes Instrument (iCOO): A New Outcome for Infants and Young Children with Orofacial Clefts. Cleft Palate Craniofac J 2021; 59:1233-1245. [PMID: 34514868 DOI: 10.1177/10556656211040307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We evaluated the measurement properties for item and domain scores of the Infant with Clefts Observation Outcomes Instrument (iCOO). DESIGN Cross-sectional (before lip surgery) and longitudinal study (preoperative baseline and 2 days and 2 months after lip surgery). SETTING Three academic craniofacial centers and national online advertisements. PARTICIPANTS Primary caregivers with an infant with cleft lip with or without cleft palate (CL ± P) scheduled to undergo primary lip repair. There were 133 primary caregivers at baseline, 115 at 2 days postsurgery, and 112 at 2 months postsurgery. MAIN OUTCOME MEASURE(S) Caregiver observation items (n = 61) and global impression of health and function items (n = 8) across eight health domains. RESULTS Mean age at surgery was 6.0 months (range 2.7-11.8 months). Five of eight iCOO domains have scale scores, with Cronbach's alphas ranging from 0.67 to 0.87. Except for the Facial Skin and Mouth domain, iCOO scales had acceptable intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.84. The internal consistency of the Global Impression items across all domains was 0.90 and had acceptable ICCs (range 0.76-0.91). Sixteen out of 20 (nonscale) items had acceptable ICCs (range 0.66-0.96). As anticipated, iCOO scores 2 days postoperatively were generally lower than baseline and scores 2 months postsurgery were consistent with baseline or higher. The iCOO took approximately 10 min to complete. CONCLUSIONS The iCOO meets measurement standards and may be used for assessing the impact of cleft-related treatments in clinical research and care. More research is needed on its use in various treatment contexts.
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Affiliation(s)
| | - Carrie L Heike
- 7284University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Laura P Stueckle
- Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - Claudia Crilly Bellucci
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | - Janine M Rosenberg
- University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - Meredith Albert
- Shriners Hospital for Children, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL, USA
| | - Cassandra L Aspinall
- Seattle Children's Research Institute, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
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16
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Liu D, Alhazmi N, Matthews H, Lee MK, Li J, Hecht JT, Wehby GL, Moreno LM, Heike CL, Roosenboom J, Feingold E, Marazita ML, Claes P, Liao EC, Weinberg SM, Shaffer JR. Impact of low-frequency coding variants on human facial shape. Sci Rep 2021; 11:748. [PMID: 33436952 PMCID: PMC7804299 DOI: 10.1038/s41598-020-80661-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/18/2020] [Indexed: 01/29/2023] Open
Abstract
The contribution of low-frequency variants to the genetic architecture of normal-range facial traits is unknown. We studied the influence of low-frequency coding variants (MAF < 1%) in 8091 genes on multi-dimensional facial shape phenotypes in a European cohort of 2329 healthy individuals. Using three-dimensional images, we partitioned the full face into 31 hierarchically arranged segments to model facial morphology at multiple levels, and generated multi-dimensional phenotypes representing the shape variation within each segment. We used MultiSKAT, a multivariate kernel regression approach to scan the exome for face-associated low-frequency variants in a gene-based manner. After accounting for multiple tests, seven genes (AR, CARS2, FTSJ1, HFE, LTB4R, TELO2, NECTIN1) were significantly associated with shape variation of the cheek, chin, nose and mouth areas. These genes displayed a wide range of phenotypic effects, with some impacting the full face and others affecting localized regions. The missense variant rs142863092 in NECTIN1 had a significant effect on chin morphology and was predicted bioinformatically to have a deleterious effect on protein function. Notably, NECTIN1 is an established craniofacial gene that underlies a human syndrome that includes a mandibular phenotype. We further showed that nectin1a mutations can affect zebrafish craniofacial development, with the size and shape of the mandibular cartilage altered in mutant animals. Findings from this study expanded our understanding of the genetic basis of normal-range facial shape by highlighting the role of low-frequency coding variants in several novel genes.
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Affiliation(s)
- Dongjing Liu
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nora Alhazmi
- Department of Oral Biology, Harvard School of Dental Medicine, Boston, MA, USA
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Harold Matthews
- Department of Human Genetics, KU Leuven, Leuven, Belgium
- Medical Imaging Research Center, UZ Gasthuisberg, Leuven, Belgium
| | - Myoung Keun Lee
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiarui Li
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Jacqueline T Hecht
- Department of Pediatrics, University of Texas McGovern Medical Center, Houston, TX, USA
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
| | - Lina M Moreno
- Department of Orthodontics, University of Iowa, Iowa City, IA, USA
| | - Carrie L Heike
- Department of Pediatrics, Seattle Children's Craniofacial Center, University of Washington, Seattle, WA, USA
| | - Jasmien Roosenboom
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eleanor Feingold
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Marazita
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter Claes
- Department of Human Genetics, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Eric C Liao
- Department of Surgery, Center for Regenerative Medicine, Massachusetts General Hospital, Shriners Hospital, Boston, MA, USA
| | - Seth M Weinberg
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - John R Shaffer
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Collett BR, Wallace ER, Kapp-Simon KA, Johns AL, Drake AF, Heike CL, Kinter S, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Cognitive, Motor, and Language Development of Preschool Children With Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:1169-1177. [PMID: 33322943 DOI: 10.1177/1055665620980223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine neurodevelopment in preschool-aged children with craniofacial microsomia (CFM) relative to unaffected peers. DESIGN Multisite, longitudinal cohort study. SETTING Tertiary care centers in the United States. PARTICIPANTS We included 92 children with CFM ("cases") through craniofacial centers and clinics. Seventy-six children without CFM (controls) were included from pediatric practices and community advertisements. This study reports on outcomes assessed when participants were an average age of 38.4 months (SD = 1.9). MAIN OUTCOME MEASURES We assessed cognitive and motor skills using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), and language function using subtests from the Clinical Evaluation of Language Fundamentals-Preschool, second edition (CELF-P2). RESULTS Case-control differences were negligible for Bayley-III cognitive (effect sizes [ES] = -0.06, P = .72) and motor outcomes (ES = -0.19, P = .25). Cases scored lower than controls on most scales of the CELF-P2 (ES = -0.58 to -0.20, P = .01 to .26). Frequency counts for "developmental delay" (ie, one or more scores > 1 SD below the normative mean) were higher for cases (39%) than controls (15%); however, the adjusted odds ratio = 1.73 (P = 0.21) was not significant. Case-control differences were most evident in children with microtia or other combinations of CFM-related facial features. CONCLUSIONS Cognitive and motor scores were similar for preschool-aged children with and without CFM. However, children with CFM scored lower than controls on language measures. We recommend early monitoring of language to identify preschoolers with CFM who could benefit from intervention.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago and 24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Alexis L Johns
- Clinical Pediatrics, 5150Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara Kinter
- Seattle Children's Craniofacial Center, Seattle, WA, USA
| | - Daniela V Luquetti
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
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18
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Umbaugh HM, Crerand CE, Stock NM, Luquetti DV, Heike CL, Drake AF, Billaud Feragen KJ, Johns AL. Microtia and craniofacial microsomia: Content analysis of facebook groups. Int J Pediatr Otorhinolaryngol 2020; 138:110301. [PMID: 32838996 DOI: 10.1016/j.ijporl.2020.110301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An increasing number of patients use social media for health-related information and social support. This study's objective was to describe the content posted on Facebook groups for individuals with microtia and/or craniofacial microsomia (CFM) and their families in order for providers to gain insight into patient and family needs and experiences to inform clinical care. METHODS Two months of posts, images, comments, and "like" responses from two Facebook groups in the US and the UK were recorded and analyzed using content analysis. A secondary analysis identified statements of emotion. RESULTS Posts (N = 254) had a total of 7912 "like" responses, 2245 comments, and 153 images. There were three categories of posts: seeking guidance (43%; 9 themes), promoting events/news (33%; 5 themes), and sharing experiences (24%; 3 themes). Across categories, 16% of posts had emotional content. Most comments were responding to posts seeking guidance, including medical care (20%), surgical care (9%), and hearing aids (5%). Promotional posts often aimed to increase CFM awareness. Posts sharing experiences were generally positive, with the highest number of "likes". CONCLUSIONS Facebook groups members frequently exchanged health-related information, suggesting value placed on input from other families and the convenience of seeking information online. Posts also promoted awareness and shared experiences. Clinical care implications include the need for easily accessible accurate and tailored CFM-related health education. Additionally, providers should demonstrate awareness of health information on social media and may address the potential emotional impact of CFM by facilitating access to resources for social support.
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Affiliation(s)
- Hailey M Umbaugh
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, FOB Suite 3A.1, Columbus, OH, 43205, USA.
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, FOB Suite 3A.1, Columbus, OH, 43205, USA; Department of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, USA.
| | - Nicola M Stock
- Center for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Daniela V Luquetti
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, Craniofacial Center, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Kristin J Billaud Feragen
- Center for Rare Disorders, Oslo University Hospital (Rikshospitalet), Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#96, Los Angeles, CA, 90027, USA.
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19
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Luquetti DV, Heike CL, Zarante I, Timms AE, Gustafson J, Pachajoa H, Porras-Hurtado GL, Ayala-Ramirez P, Duenas-Roque MM, Jimenez N, Ibanez LM, Hurtado-Villa P. MYT1 role in the microtia-craniofacial microsomia spectrum. Mol Genet Genomic Med 2020; 8:e1401. [PMID: 32871052 PMCID: PMC7549594 DOI: 10.1002/mgg3.1401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 01/13/2023] Open
Abstract
Background Craniofacial microsomia (CFM), also known as the oculo‐auriculo‐vertebral spectrum, comprises a variable phenotype with the most common features including microtia and mandibular hypoplasia on one or both sides, in addition to lateral oral clefts, epibulbar dermoids, cardiac, vertebral, and renal abnormalities. The etiology of CFM is largely unknown. The MYT1 gene has been reported as a candidate based in mutations found in three unrelated individuals. Additional patients with mutations in this gene are required to establish its causality. We present two individuals with CFM that have rare variants in MYT1 contributing to better understand the genotype and phenotype associated with mutations in this gene. Methods/Results We conducted genetic analysis using whole‐exome and ‐genome sequencing in 128 trios with CFM. Two novel MYT1 mutations were identified in two participants. Sanger sequencing was used to confirm these mutations. Conclusion We identified two additional individuals with CFM who carry rare variants in MYT1, further supporting the presumptive role of this gene in the CFM spectrum.
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Affiliation(s)
- Daniela V Luquetti
- University of Washington School of Medicine, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Carrie L Heike
- University of Washington School of Medicine, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Ignacio Zarante
- Human Genomics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | | | | | - Paola Ayala-Ramirez
- Human Genomics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
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20
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Johns AL, Wallace ER, Collett BR, Kapp-Simon KA, Drake AF, Heike CL, Kinter SL, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Behavioral Adjustment of Preschool Children With and Without Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:42-53. [PMID: 32783465 DOI: 10.1177/1055665620947987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The study aim was to assess behavioral adjustment in preschool children with and without craniofacial microsomia (CFM). DESIGN Multisite cohort study of preschoolers with CFM ("cases") or without CFM ("controls"). PARTICIPANTS Mothers (89%), fathers (9%), and other caregivers (2%) of 161 preschoolers. OUTCOME MEASURE Child Behavior Check List (CBCL 1.5-5); linear regressions with standardized effect sizes (ES) adjusted for sociodemographic confounds. RESULTS Child Behavior Check Lists for 89 cases and 72 controls (average age 38.3 ± 1.9 months). Children were male (54%), white (69%), and of Latino ethnicity (47%). Cases had microtia with mandibular hypoplasia (52%), microtia only (30%), or other CFM-associated features (18%). Nearly 20% of cases had extracranial anomalies. Composite CBCL scores were in the average range compared to test norms and similar for cases and controls. On the subscales, cases' parents reported higher Anxious/Depressed scores (ES = 0.35, P = .04), Stress Problems (ES = 0.40, P = .04), Anxiety Problems (ES = 0.34, P = .04), and Autism Spectrum Problems (ES = 0.41, P = .02); however, the autism subscale primarily reflected speech concerns. Among cases, more problems were reported for children with extracranial anomalies and certain phenotypic categories with small ES. CONCLUSIONS Behavioral adjustment of preschoolers with CFM was comparable to peers. However, parental reports reflected greater concern for internalizing behaviors; thus, anxiety screening and interventions may benefit children with CFM. Among cases, more problems were reported for those with more complex presentations of CFM. Craniofacial microsomia-related speech problems should be distinguished from associated psychosocial symptoms during developmental evaluations.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.,24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Amelia F Drake
- Otolaryngology, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Craniofacial Center, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara L Kinter
- Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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21
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Wenger TL, Bly RA, Wu N, Albert CM, Park J, Shieh J, Chenbhanich J, Heike CL, Adam MP, Chang I, Sun A, Miller DE, Beck AE, Gupta D, Boos MD, Zackai EH, Everman D, Ganapathi S, Wilson M, Christodoulou J, Zarate YA, Curry C, Li D, Guimier A, Amiel J, Hakonarson H, Webster R, Bhoj EJ, Perkins JA, Dahl JP, Dobyns WB. Activating variants in PDGFRB result in a spectrum of disorders responsive to imatinib monotherapy. Am J Med Genet A 2020; 182:1576-1591. [PMID: 32500973 DOI: 10.1002/ajmg.a.61615] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Abstract
More than 50 individuals with activating variants in the receptor tyrosine kinase PDGFRB have been reported, separated based on clinical features into solitary myofibromas, infantile myofibromatosis, Penttinen syndrome with premature aging and osteopenia, Kosaki overgrowth syndrome, and fusiform aneurysms. Despite their descriptions as distinct clinical entities, review of previous reports demonstrates substantial phenotypic overlap. We present a case series of 12 patients with activating variants in PDGFRB and review of the literature. We describe five patients with PDGFRB activating variants whose clinical features overlap multiple diagnostic entities. Seven additional patients from a large family had variable expressivity and late-onset disease, including adult onset features and two individuals with sudden death. Three patients were treated with imatinib and had robust and rapid response, including the first two reported infants with multicentric myofibromas treated with imatinib monotherapy and one with a recurrent p.Val665Ala (Penttinen) variant. Along with previously reported individuals, our cohort suggests infants and young children had few abnormal features, while older individuals had multiple additional features, several of which appeared to worsen with advancing age. Our analysis supports a diagnostic entity of a spectrum disorders due to activating variants in PDGFRB. Differences in reported phenotypes can be dramatic and correlate with advancing age, genotype, and to mosaicism in some individuals.
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Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Natalie Wu
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Catherine M Albert
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Julie Park
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joseph Shieh
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Jirat Chenbhanich
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Margaret P Adam
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Irene Chang
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Sun
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Danny E Miller
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Anita E Beck
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Everman
- Greenwood Genetics Center, Greenville, South Carolina, USA
| | - Shireen Ganapathi
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Meredith Wilson
- Department of Clinical Genetics, Sydney Children's Hospitals Network-Westmead, University of Sydney, Sydney, New South Wales, Australia.,Division of Genetic Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - John Christodoulou
- Murdoch Children's Research Institute, Parkville, Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cynthia Curry
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Guimier
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Webster
- Department of Neurology, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Elizabeth J Bhoj
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan A Perkins
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - William B Dobyns
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
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22
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Heike CL, Albert M, Aspinall CL, Bautista S, Bellucci CC, Kapp-Simon KA, Mecham S, Patrick DL, Rosenberg J, Siebold B, Stueckle LP, Edwards TC. Development of an Outcome Measure of Observable Signs of Health and Well-Being in Infants With Orofacial Clefts. Cleft Palate Craniofac J 2020; 57:1266-1279. [PMID: 32468839 DOI: 10.1177/1055665620922105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To develop an outcomes instrument that assesses observations that can be reliably reported by caregivers and can be used to assess health of infants with a cleft lip or cleft lip and cleft palate (CL±P) and impacts of treatments. DESIGN Cross-sectional, mixed methods study. SETTING Caregivers and health-care providers were recruited from 3 academic craniofacial centers and national advertisements. Most interviews were conducted by telephone, and surveys were completed online. PARTICIPANTS Caregivers had a child less than 3 years of age with CL±P and spoke either English or Spanish. Health-care providers were members of a cleft team. Caregivers (n = 492) and health-care professionals (n = 75) participated in at least one component of this study. MAIN OUTCOME MEASURE(S) Caregivers and health-care providers participated in tasks related to instrument development: concept elicitation for items within relevant health domains, prioritization of items, and item review. RESULTS We identified 295 observations of infant well-being across 9 health areas. Research staff and specialists evaluated items for clarity, specificity to CL±P, and responsiveness to treatment. Caregivers and health-care providers rated the resulting list of 104 observations and developed the final instrument of 65 items. CONCLUSIONS In this phase of development of the Infant with Clefts Observation Outcomes (iCOO) instrument, items were developed to collect caregiver observations about indicators of children's health and well-being across multiple domains allowing for psychometric testing, sensitivity to changes associated with treatment, and documentation of the effects of treatment.
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Affiliation(s)
- Carrie L Heike
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Meredith Albert
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Cassandra L Aspinall
- 7274Seattle Children's Hospital, Seattle, WA, USA.,7284University of Washington, Seattle, WA, USA
| | - Suzel Bautista
- 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Claudia Crilly Bellucci
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen A Kapp-Simon
- Shriners Hospital for Children, Chicago, IL, USA.,14681University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Janine Rosenberg
- 21725University of Illinois Hospital and Health Science System, Chicago, IL, USA
| | - Babette Siebold
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
| | - Laura P Stueckle
- Seattle Children's Research Institute, Seattle, WA, USA.,7274Seattle Children's Hospital, Seattle, WA, USA
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23
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Collett BR, Chapman K, Wallace ER, Kinter SL, Heike CL, Speltz ML, Werler M. Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia. Am J Speech Lang Pathol 2019; 28:1571-1581. [PMID: 31580699 PMCID: PMC7251598 DOI: 10.1044/2019_ajslp-19-0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Erin R Wallace
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | | | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
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24
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Siebold B, Heike CL, Leroux BG, Speltz ML, Drake AF, Johns AL, Kapp-Simon KA, Magee L, Luquetti DV. Evaluation of prenatal diabetes mellitus and other risk factors for craniofacial microsomia. Birth Defects Res 2019; 111:649-658. [PMID: 30927385 DOI: 10.1002/bdr2.1502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/03/2019] [Accepted: 03/13/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Craniofacial microsomia (CFM) is a congenital condition that typically involves hypoplasia of the ear and jaw. It is often associated with adverse effects such as hearing loss and sleep-disordered breathing. There is little research on its etiology. METHODS We conducted a case-control study from maternal interview data collected from mothers of infants with and without CFM. The study included 108 children with and 84 children without CFM. Logistic regression with adjustment for demographic factors was used to evaluate associations between maternal exposures of interest and risk for CFM overall, as well as for different phenotypic sub-groups of children on the CFM spectrum. RESULTS We found a statistically significant association between diabetes mellitus (DM) and CFM (OR 4.01, 95% CI 1.6-10.5). The association was slightly attenuated after adjustment for BMI. Higher parity was also associated with increased risk for CFM (OR 2.0, 95% CI 1.0-4.0). Vitamin A consumption and/or liver consumption was associated with a 70% lower risk compared with non-users (OR 0.3, 95% 0.1-0.8). Maternal age at the time of pregnancy was not associated with CFM. CONCLUSIONS These analyses contribute evidence linking maternal DM with an elevated risk of having an infant with CFM, which is consistent with previous research and adds to the body of knowledge about the strength of this association. Further study is warranted to understand the potential mechanisms underlying the effect of DM in the developing embryo.
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Affiliation(s)
- Babette Siebold
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington.,Craniofacial Division, Seattle Children's Hospital, Seattle, Washington
| | - Carrie L Heike
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington.,Craniofacial Division, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, Division of Craniofacial Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Brian G Leroux
- Department of Biostatistics, University of Washington School of Dentistry, Seattle, Washington
| | - Matthew L Speltz
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington.,Craniofacial Division, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, Division of Craniofacial Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Center, Shriners Hospital for Children, Chicago, Illinois.,Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniela V Luquetti
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington.,Craniofacial Division, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, Division of Craniofacial Medicine, University of Washington School of Medicine, Seattle, Washington
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25
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Weiss EM, Clark JD, Heike CL, Rosenberg AR, Shah SK, Wilfond BS, Opel DJ. Gaps in the Implementation of Shared Decision-making: Illustrative Cases. Pediatrics 2019; 143:peds.2018-3055. [PMID: 30824603 DOI: 10.1542/peds.2018-3055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) has emerged as the preferred decision-making model in the clinician-patient relationship. Through collaboration, SDM helps to facilitate evidence-based medical decisions that are closely aligned with patient or surrogate preferences, values, and goals. How to implement SDM in clinical pediatric practice, however, remains elusive, in part because SDM in pediatrics is complicated by the involvement of parents as a special class of surrogate decision-maker. A provisional framework for the process of SDM in pediatrics was recently proposed by Opel to help facilitate its implementation. To identify aspects of the framework that require refinement, we applied it across a diverse range of clinical cases from multiple pediatric specialties. In doing so, several questions surfaced that deserve further scrutiny: (1) For which medical decisions is consideration of SDM required? (2) What is considered medically reasonable when there is variability in standard practice? (3) Can an option that is not consistent with standard practice still be medically reasonable? (4) How should public health implications be factored into SDM? (5) How should variability in preference sensitivity be approached? (6) How should the developing autonomy of adolescents be integrated into SDM?; and (7) How should SDM address parental decisional burden for emotionally charged decisions? We conduct a brief analysis of each question raised to illustrate key areas for future research.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington; .,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Jonna D Clark
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Carrie L Heike
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Abby R Rosenberg
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Seema K Shah
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and
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26
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Luquetti DV, Speltz ML, Wallace ER, Siebold B, Collett BR, Drake AF, Johns AL, Kapp-Simon KA, Kinter SL, Leroux BG, Magee L, Norton S, Sie K, Heike CL. Methods and Challenges in a Cohort Study of Infants and Toddlers With Craniofacial Microsomia: The Clock Study. Cleft Palate Craniofac J 2019; 56:877-889. [PMID: 30621445 DOI: 10.1177/1055665618821014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Craniofacial microsomia: Longitudinal Outcomes in Children pre-Kindergarten (CLOCK) study is a longitudinal cohort study of neurobehavioral outcomes in infants and toddlers with craniofacial microsomia (CFM). In this article, we review the data collection and methods used to characterize this complex condition and describe the demographic and clinical characteristics of the cohort. SETTING Craniofacial and otolaryngology clinics at 5 study sites. PARTICIPANTS Infants with CFM and unaffected infants (controls) ages 12 to 24 months were recruited from the same geographical regions and followed to age 36 to 48 months. METHODS Phenotypic, neurodevelopmental, and facial expression assessments were completed during the first and third waves of data collection (time 1 and time 3, respectively). Medical history data were taken at both of these time points and during an intermediate parent phone interview (time 2). RESULTS Our cohort includes 108 cases and 84 controls. Most cases and controls identified as white and 55% of cases and 37% of controls identified as Hispanic. Nearly all cases had microtia (95%) and 59% had mandibular hypoplasia. Cases received extensive clinical care in infancy, with 59% receiving care in a craniofacial clinic and 28% experiencing at least one surgery. Study visits were completed at a study site (92%) or at the participant's home (8%). CONCLUSIONS The CLOCK study represents an effort to overcome the challenges of characterizing the phenotypic and neurodevelopmental outcomes of CFM in a large, demographically and geographically diverse cohort.
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Affiliation(s)
- Daniela V Luquetti
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew L Speltz
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Erin R Wallace
- 1 Seattle Children's Research Institute, Seattle, WA, USA
| | - Babette Siebold
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brent R Collett
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Kathleen A Kapp-Simon
- 6 Shriners Hospitals for Children, Chicago, IL, USA.,7 University of Illinois, Chicago, IL, USA
| | - Sara L Kinter
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brian G Leroux
- 8 University of Washington School of Dentistry, Seattle, WA, USA
| | - Leanne Magee
- 9 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen Sie
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Johns AL, Luquetti DV, Brajcich MR, Heike CL, Stock NM. In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care. J Craniofac Surg 2018; 29:2198-2205. [PMID: 30334912 PMCID: PMC6224304 DOI: 10.1097/scs.0000000000004867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers' and patients' responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare.
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Affiliation(s)
- Alexis L. Johns
- Division of Plastic and Maxillofacial Surgery; Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniela V. Luquetti
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | - Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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28
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Rosenberg J, Albert M, Aspinall C, Bautista S, Crilly Bellucci C, Edwards TC, Heike CL, Mecham SH, Patrick DL, Stueckle L, Kapp-Simon K. Parent Observations of the Health Status of Infants With Clefts of the Lip: Results From Qualitative Interviews. Cleft Palate Craniofac J 2018; 56:646-657. [PMID: 30092661 DOI: 10.1177/1055665618793062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore, using semistructured qualitative interviews, parent observations of their infant's health as they relate to having a cleft lip or cleft lip and cleft palate (CL±P) and/or associated treatments. DESIGN Cross-sectional, qualitative study across 3 sites. SETTING Parents were recruited from 3 academic craniofacial centers. Most interviews were conducted over the telephone, audio-recorded, and transcribed. PARTICIPANTS Forty-one parents (31 English-, 10 Spanish-speaking) were interviewed. Parents had a child ages 1 to 35 months diagnosed with CL±P. MAIN OUTCOME MEASURE(S) Twelve domains reflecting infant health and well-being, likely affected by a CL±P and/or associated treatments, were identified from clinical experience and literature review. Study investigators conducted semistructured interviews based on 12 identified domains. After transcripts of the interviews were reviewed, our multidisciplinary team selected illustrative quotes from each domain that reflected consistent observations made by parents. RESULTS Parents' responses covered all 12 domains. Specifically, parents discussed the domain of feeding most frequently, followed by observations about sleep, development, comfort, breathing, and vocalization. CONCLUSIONS We found that parents of infants with clefts provided caregiver-centered language useful in describing their daily observations. No additional domains of infant health were noted by parents. We will use these observations and language to develop and validate a parent-reported observation diary that can augment assessments of the impacts of interventions on infants who are receiving care for CL±P.
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Affiliation(s)
- Janine Rosenberg
- 1 University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | | | | | - Suzel Bautista
- 1 University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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29
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Speltz ML, Kapp-Simon KA, Johns AL, Wallace ER, Collett BR, Magee L, Leroux BG, Luquetti DV, Heike CL. Neurodevelopment of Infants with and without Craniofacial Microsomia. J Pediatr 2018; 198:226-233.e3. [PMID: 29685618 PMCID: PMC6019149 DOI: 10.1016/j.jpeds.2018.02.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether infant cases with craniofacial microsomia (CFM) evidence poorer neurodevelopmental status than demographically similar infants without craniofacial diagnoses ("controls"), and to examine cases' neurodevelopmental outcomes by facial phenotype and hearing status. STUDY DESIGN Multicenter, observational study of 108 cases and 84 controls aged 12-24 months. Participants were assessed by the Bayley Scales of Infant and Toddler Development-Third Edition and the Preschool Language Scales-Fifth Edition (PLS-5). Facial features were classified with the Phenotypic Assessment Tool for Craniofacial Microsomia. RESULTS After adjustment for demographic variables, there was little difference in Bayley Scales of Infant and Toddler Development-Third Edition or Preschool Language Scales-Fifth Edition outcomes between cases and controls. Estimates of mean differences ranged from -0.23 to 1.79 corresponding to standardized effect sizes of -.02 to 0.12 (P values from .30 to .88). Outcomes were better among females and those with higher socioeconomic status. Among cases, facial phenotype and hearing status showed little to no association with outcomes. Analysis of individual test scores indicated that 21% of cases and 16% of controls were developmentally delayed (OR 0.68, 95% CI 0.29-1.61). CONCLUSIONS Although learning problems have been observed in older children with CFM, we found no evidence of developmental or language delay among infants. Variation in outcomes across prior studies may reflect differences in ascertainment methods and CFM diagnostic criteria.
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Affiliation(s)
- Matthew L Speltz
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Center, Shriners Hospital for Children, Chicago, IL; Craniofacial Center, Department of Surgery, University of Illinois, Chicago, IL
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Erin R Wallace
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Brent R Collett
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian G Leroux
- University of Washington School of Dentistry, Seattle, WA
| | - Daniela V Luquetti
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Carrie L Heike
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
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Hammal Z, Cohn JF, Wallace ER, Heike CL, Birgfeld CB, Oster H, Speltz ML. Facial Expressiveness in Infants With and Without Craniofacial Microsomia: Preliminary Findings. Cleft Palate Craniofac J 2018; 55:711-720. [PMID: 29377723 PMCID: PMC5936082 DOI: 10.1177/1055665617753481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare facial expressiveness (FE) of infants with and without craniofacial macrosomia (cases and controls, respectively) and to compare phenotypic variation among cases in relation to FE. DESIGN Positive and negative affect was elicited in response to standardized emotion inductions, video recorded, and manually coded from video using the Facial Action Coding System for Infants and Young Children. SETTING Five craniofacial centers: Children's Hospital of Los Angeles, Children's Hospital of Philadelphia, Seattle Children's Hospital, University of Illinois-Chicago, and University of North Carolina-Chapel Hill. PARTICIPANTS Eighty ethnically diverse 12- to 14-month-old infants. MAIN OUTCOME MEASURES FE was measured on a frame-by-frame basis as the sum of 9 observed facial action units (AUs) representative of positive and negative affect. RESULTS FE differed between conditions intended to elicit positive and negative affect (95% confidence interval = 0.09-0.66, P = .01). FE failed to differ between cases and controls (ES = -0.16 to -0.02, P = .47 to .92). Among cases, those with and without mandibular hypoplasia showed similar levels of FE (ES = -0.38 to 0.54, P = .10 to .66). CONCLUSIONS FE varied between positive and negative affect, and cases and controls responded similarly. Null findings for case/control differences may be attributable to a lower than anticipated prevalence of nerve palsy among cases, the selection of AUs, or the use of manual coding. In future research, we will reexamine group differences using an automated, computer vision approach that can cover a broader range of facial movements and their dynamics.
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Affiliation(s)
- Zakia Hammal
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jeffrey F. Cohn
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Research Institute, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Craig B. Birgfeld
- Seattle Children’s Research Institute, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Harriet Oster
- NYU School of Professional Studies, New York, NY, USA
| | - Matthew L. Speltz
- Seattle Children’s Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
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31
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Roosenboom J, Lee MK, Hecht JT, Heike CL, Wehby GL, Christensen K, Feingold E, Marazita ML, Maga AM, Shaffer JR, Weinberg SM. Mapping genetic variants for cranial vault shape in humans. PLoS One 2018; 13:e0196148. [PMID: 29698431 PMCID: PMC5919379 DOI: 10.1371/journal.pone.0196148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/07/2018] [Indexed: 01/17/2023] Open
Abstract
The shape of the cranial vault, a region comprising interlocking flat bones surrounding the cerebral cortex, varies considerably in humans. Strongly influenced by brain size and shape, cranial vault morphology has both clinical and evolutionary relevance. However, little is known about the genetic basis of normal vault shape in humans. We performed a genome-wide association study (GWAS) on three vault measures (maximum cranial width [MCW], maximum cranial length [MCL], and cephalic index [CI]) in a sample of 4419 healthy individuals of European ancestry. All measures were adjusted by sex, age, and body size, then tested for association with genetic variants spanning the genome. GWAS results for the two cohorts were combined via meta-analysis. Significant associations were observed at two loci: 15p11.2 (lead SNP rs2924767, p = 2.107 × 10−8) for MCW and 17q11.2 (lead SNP rs72841279, p = 5.29 × 10−9) for MCL. Additionally, 32 suggestive loci (p < 5x10-6) were observed. Several candidate genes were located in these loci, such as NLK, MEF2A, SOX9 and SOX11. Genome-wide linkage analysis of cranial vault shape in mice (N = 433) was performed to follow-up the associated candidate loci identified in the human GWAS. Two loci, 17q11.2 (c11.loc44 in mice) and 17q25.1 (c11.loc74 in mice), associated with cranial vault size in humans, were also linked with cranial vault size in mice (LOD scores: 3.37 and 3.79 respectively). These results provide further insight into genetic pathways and mechanisms underlying normal variation in human craniofacial morphology.
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Affiliation(s)
- Jasmien Roosenboom
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Myoung Keun Lee
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jacqueline T. Hecht
- Department of Pediatrics, University of Texas McGovern Medical Center, Houston, TX, United States of America
| | - Carrie L. Heike
- Department of Pediatrics, Seattle Children’s Craniofacial Center, University of Washington, Seattle, WA, United States of America
| | - George L. Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, United States of America
| | - Kaare Christensen
- Department of Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eleanor Feingold
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Mary L. Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - A. Murat Maga
- Department of Pediatrics, Seattle Children’s Craniofacial Center, University of Washington, Seattle, WA, United States of America
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute Seattle, WA, United States of America
| | - John R. Shaffer
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Seth M. Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Anthropology, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
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32
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Luquetti DV, Brajcich MR, Stock NM, Heike CL, Johns AL. Healthcare and psychosocial experiences of individuals with craniofacial microsomia: Patient and caregivers perspectives. Int J Pediatr Otorhinolaryngol 2018; 107:164-175. [PMID: 29501301 PMCID: PMC5839339 DOI: 10.1016/j.ijporl.2018.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/03/2018] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Craniofacial microsomia (CFM) is primarily characterized by underdevelopment of the ear and mandible, with several additional possible congenital anomalies. Despite the potential burden of care and impact of CFM on multiple domains of functioning, few studies have investigated patient and caregiver perspectives. The objective of this study was to explore the diagnostic, treatment-related, and early psychosocial experiences of families with CFM with the aim of optimizing future healthcare delivery. METHODS Forty-two caregivers and nine adults with CFM responded to an online mixed-methods survey. Descriptive statistics and qualitative methods were used for the analysis. RESULTS Survey respondents reported high rates of subspecialty evaluations, surgeries, and participation in therapies. Some participants reported receiving inaccurate or incomplete information about CFM and experienced confusion about etiology. Communication about CFM among family members included mostly positive messages. Self-awareness of facial differences began at a mean age of three years and teasing at mean age six, with 43% of individuals four years or older reporting teasing. Teasing often involved name-calling and frequent reactions were ignoring and negative emotional responses. Participants ranked "understanding diagnosis and treatment" as a top priority for future research and had the most questions about etiology and treatment guidance. CONCLUSIONS The survey results on the healthcare and psychosocial experiences from birth through adulthood of individuals with CFM reinforce the need for ongoing psychological assessment and intervention. Healthcare provision could be improved through establishing diagnostic criteria and standardized treatment guidelines, as well as continued investigation of CFM etiology.
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Affiliation(s)
- Daniela V Luquetti
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Michelle R Brajcich
- University of Washington, School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle Children's Research Institute, University of Washington, Department of Pediatrics, 1900 Ninth Avenue, Mailstop C9S-5, Seattle, WA, 98101, USA.
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #96, Los Angeles, CA, 90027, USA.
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Wallace ER, Collett BR, Heike CL, Werler MM, Speltz ML. Behavioral-Social Adjustment of Adolescents with Craniofacial Microsomia. Cleft Palate Craniofac J 2018; 55:664-675. [PMID: 29356621 DOI: 10.1177/1055665617750488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective was to assess differences in psychosocial adjustment between adolescents with and without craniofacial microsomia (CFM). DESIGN This is a case-control follow-up study in adolescents with and without CFM. SETTING Participants were originally recruited as infants from 26 cities across the United States and Canada. PARTICIPANTS Participants included 142 adolescents with CFM (cases) and 316 peers without CFM (controls), their caregivers, and their teachers. MAIN OUTCOME MEASURES Social and behavior measures from the Achenbach System of Empirically Based Assessments (ASEBA), the PedsQL: Core Version, and the Children's Communication Checklist-2nd edition (CCC-2) were used. Linear regression was used to estimate case-control differences and corresponding standardized effect sizes (ES) and 95% confidence intervals after adjustment for sociodemographic confounds. We also examined case-control differences by facial phenotype and hearing status. RESULTS The magnitude and direction of case-control differences varied across assessment and respondent, but were generally modest (ES = -0.4 to 0.02, P values ranged from .003 to .85). There was little evidence for variation in case-control differences across different facial phenotypes or as a function of hearing status. CONCLUSIONS Our results suggest that in spite of multiple risk factors, adolescents with CFM exhibit behavior problems no more frequently than their peers without CFM. Future studies of individuals with CFM should focus on resilience and social coping mechanisms, in addition to maladjustment.
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Affiliation(s)
- Erin R Wallace
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.,2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 4 Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,5 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Matthew L Speltz
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.,2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Heike CL, Avellino AM, Mirza SK, Kifle Y, Perkins J, Sze R, Egbert M, Hing AV. Sleep Disturbances in 22q11.2 Deletion Syndrome: A Case with Obstructive and Central Sleep Apnea. Cleft Palate Craniofac J 2017; 44:340-6. [PMID: 17477750 DOI: 10.1597/05-196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The 22q11.2 deletion syndrome is characterized by wide phenotypic variability, frequently involving characteristic craniofacial features, cardiac malformations, and learning difficulties. Skeletal anomalies are also common and include an obtuse angle of the cranial base, retrognathia, and cervical spine abnormalities. Despite these anomalies, sleep-disturbed breathing is not reported frequently in patients with 22q11.2 deletion syndrome. We describe a patient with an obstructive sleep disturbance that was successfully treated with a tonsillectomy followed by mandibular distraction osteogenesis. She also had central sleep apnea, initially attributed to spinal cord impingement from cervical instability. Posterior cervical fusion was associated with a decrease in the number of central apneic events.
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MESH Headings
- Child, Preschool
- Chromosome Deletion
- Chromosomes, Human, Pair 22/genetics
- Cleft Lip/genetics
- Cleft Lip/surgery
- Cleft Palate/genetics
- Cleft Palate/surgery
- Craniofacial Abnormalities/complications
- Craniofacial Abnormalities/genetics
- Craniofacial Abnormalities/therapy
- Female
- Humans
- Infant
- Mandibular Advancement/methods
- Micrognathism/complications
- Micrognathism/genetics
- Micrognathism/surgery
- Odontoid Process/abnormalities
- Odontoid Process/diagnostic imaging
- Odontoid Process/surgery
- Osteogenesis, Distraction/methods
- Polysomnography
- Radiography
- Sleep Apnea, Central/etiology
- Sleep Apnea, Central/genetics
- Sleep Apnea, Central/therapy
- Sleep Apnea, Obstructive/etiology
- Sleep Apnea, Obstructive/genetics
- Sleep Apnea, Obstructive/therapy
- Spinal Cord Compression/complications
- Spinal Cord Compression/diagnostic imaging
- Spinal Cord Compression/surgery
- Syndrome
- Tonsillectomy
- Treatment Outcome
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Affiliation(s)
- Carrie L Heike
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington, USA
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35
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Mitchell RM, Saltzman BS, Norton SJ, Harrison RG, Heike CL, Luquetti DV, Sie KC. Hearing Loss in Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2017; 54:656-663. [DOI: 10.1597/15-348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the association between craniofacial phenotype and hearing loss in children with craniofacial microsomia. Design Retrospective cohort study. Setting Tertiary care children's hospital. Patients Individuals with craniofacial microsomia. Main Outcome Measures Ear-specific audiograms and standardized phenotypic classification of facial characteristics. Results A total of 79 participants were included in the study. The mean age was 9 years (range, 1 to 23 years) and approximately 60% were boys. Facial anomalies were bilateral in 39 participants and unilateral in 40 participants (24 right, 16 left). Microtia (hypoplasia of the ear) was the most common feature (94%), followed by mandibular hypoplasia (76%), soft tissue deficiency (60%), orbital hypoplasia or displacement (53%), and facial nerve palsy (32%). Sixty-five individuals had hearing loss (12 bilateral and 53 unilateral). Hearing loss was conductive in 73% of affected ears, mixed in 10%, sensorineural in 1%, and indeterminate in 16%. Hypoplasia of the ear or mandible was frequently associated with ipsilateral hearing loss, although contralateral hearing loss occurred in 8% of hemifaces. Conclusions Hearing loss is strongly associated with malformations of the ipsilateral ear in craniofacial microsomia and is most commonly conductive. Hearing loss can occur contralaterally to the side with malformations in children with apparent hemifacial involvement. Children with craniofacial microsomia should receive early diagnostic hearing assessments.
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Affiliation(s)
- Ryan M. Mitchell
- Department of Otolaryngology–Head and Neck Surgery, University of Washington
| | | | - Susan J. Norton
- Division of Pediatric Audiology, Seattle Children's Hospital
| | | | - Carrie L. Heike
- Seattle Children's Hospital, and Department of Pediatrics, University of Washington
| | - Daniela V. Luquetti
- Seattle Children's Hospital, and Department of Pediatrics, University of Washington
| | - Kathleen C.Y. Sie
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, and Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington
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36
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Heike CL, Wallace E, Speltz ML, Siebold B, Werler MM, Hing AV, Birgfeld CB, Collett BR, Leroux BG, Luquetti DV. Characterizing facial features in individuals with craniofacial microsomia: A systematic approach for clinical research. ACTA ACUST UNITED AC 2016; 106:915-926. [DOI: 10.1002/bdra.23560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/22/2016] [Accepted: 07/14/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Carrie L. Heike
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Pediatrics; Seattle Washington
| | - Erin Wallace
- Seattle Children's Research Institute; Seattle Washington
| | - Matthew L. Speltz
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Psychiatry & Behavioral Sciences; Seattle Washington
| | - Babette Siebold
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
| | - Martha M. Werler
- Boston University, Epidemiology; Boston Massachusetts
- Slone Epidemiology Center; Boston Massachusetts
| | - Anne V. Hing
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Pediatrics; Seattle Washington
| | - Craig B. Birgfeld
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Surgery; Seattle Washington
| | - Brent R. Collett
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Psychiatry & Behavioral Sciences; Seattle Washington
| | - Brian G. Leroux
- University of Washington, Department of Oral Health Sciences; Seattle Washington
- University of Washington, Department of Biostatistics; Seattle Washington
| | - Daniela V. Luquetti
- Seattle Children's Hospital; Craniofacial Center; Seattle Washington
- Seattle Children's Research Institute; Seattle Washington
- University of Washington, Department of Pediatrics; Seattle Washington
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Affiliation(s)
- Carrie L Heike
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington2Center of Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington3Department of Pediatrics, University of Washington, Seattle
| | - Kelly N Evans
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington2Center of Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington3Department of Pediatrics, University of Washington, Seattle
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Shaffer JR, Orlova E, Lee MK, Leslie EJ, Raffensperger ZD, Heike CL, Cunningham ML, Hecht JT, Kau CH, Nidey NL, Moreno LM, Wehby GL, Murray JC, Laurie CA, Laurie CC, Cole J, Ferrara T, Santorico S, Klein O, Mio W, Feingold E, Hallgrimsson B, Spritz RA, Marazita ML, Weinberg SM. Genome-Wide Association Study Reveals Multiple Loci Influencing Normal Human Facial Morphology. PLoS Genet 2016; 12:e1006149. [PMID: 27560520 PMCID: PMC4999139 DOI: 10.1371/journal.pgen.1006149] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/08/2016] [Indexed: 11/19/2022] Open
Abstract
Numerous lines of evidence point to a genetic basis for facial morphology in humans, yet little is known about how specific genetic variants relate to the phenotypic expression of many common facial features. We conducted genome-wide association meta-analyses of 20 quantitative facial measurements derived from the 3D surface images of 3118 healthy individuals of European ancestry belonging to two US cohorts. Analyses were performed on just under one million genotyped SNPs (Illumina OmniExpress+Exome v1.2 array) imputed to the 1000 Genomes reference panel (Phase 3). We observed genome-wide significant associations (p < 5 x 10−8) for cranial base width at 14q21.1 and 20q12, intercanthal width at 1p13.3 and Xq13.2, nasal width at 20p11.22, nasal ala length at 14q11.2, and upper facial depth at 11q22.1. Several genes in the associated regions are known to play roles in craniofacial development or in syndromes affecting the face: MAFB, PAX9, MIPOL1, ALX3, HDAC8, and PAX1. We also tested genotype-phenotype associations reported in two previous genome-wide studies and found evidence of replication for nasal ala length and SNPs in CACNA2D3 and PRDM16. These results provide further evidence that common variants in regions harboring genes of known craniofacial function contribute to normal variation in human facial features. Improved understanding of the genes associated with facial morphology in healthy individuals can provide insights into the pathways and mechanisms controlling normal and abnormal facial morphogenesis. There is a great deal of evidence that genes influence facial appearance. This is perhaps most apparent when we look at our own families, since we are more likely to share facial features in common with our close relatives than with unrelated individuals. Nevertheless, little is known about how variation in specific regions of the genome relates to the kinds of distinguishing facial characteristics that give us our unique identities, e.g., the size and shape of our nose or how far apart our eyes are spaced. In this paper, we investigate this question by examining the association between genetic variants across the whole genome and a set of measurements designed to capture key aspects of facial form. We found evidence of genetic associations involving measures of eye, nose, and facial breadth. In several cases, implicated regions contained genes known to play roles in embryonic face formation or in syndromes in which the face is affected. Our ability to connect specific genetic variants to ubiquitous facial traits can inform our understanding of normal and abnormal craniofacial development, provide potential predictive models of evolutionary changes in human facial features, and improve our ability to create forensic facial reconstructions from DNA.
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Affiliation(s)
- John R. Shaffer
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ekaterina Orlova
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Myoung Keun Lee
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Elizabeth J. Leslie
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Zachary D. Raffensperger
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Carrie L. Heike
- Department of Pediatrics, Seattle Children’s Craniofacial Center, University of Washington, Seattle, Washington, United States of America
| | - Michael L. Cunningham
- Department of Pediatrics, Seattle Children’s Craniofacial Center, University of Washington, Seattle, Washington, United States of America
| | - Jacqueline T. Hecht
- Department of Pediatrics, University of Texas McGovern Medical Center, Houston, Texas, United States of America
| | - Chung How Kau
- Department of Orthodontics, University of Alabama, Birmingham, Alabama, United States of America
| | - Nichole L. Nidey
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Lina M. Moreno
- Department of Orthodontics, University of Iowa, Iowa City, Iowa, United States of America
- Dows Institute, University of Iowa, Iowa City, Iowa, United States of America
| | - George L. Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, United States of America
| | - Jeffrey C. Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Cecelia A. Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Cathy C. Laurie
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Joanne Cole
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Tracey Ferrara
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Stephanie Santorico
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Mathematical and Statistical Sciences, University of Colorado, Denver, Denver, Colorado, United States of America
| | - Ophir Klein
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
- Program in Craniofacial Biology, University of California, San Francisco, California, United States of America
| | - Washington Mio
- Department of Mathematics, Florida State University, Tallahassee, Florida, United States of America
| | - Eleanor Feingold
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Benedikt Hallgrimsson
- Department of Cell Biology & Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard A. Spritz
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Mary L. Marazita
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Seth M. Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Kesterke MJ, Raffensperger ZD, Heike CL, Cunningham ML, Hecht JT, Kau CH, Nidey NL, Moreno LM, Wehby GL, Marazita ML, Weinberg SM. Using the 3D Facial Norms Database to investigate craniofacial sexual dimorphism in healthy children, adolescents, and adults. Biol Sex Differ 2016; 7:23. [PMID: 27110347 PMCID: PMC4841054 DOI: 10.1186/s13293-016-0076-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/17/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although craniofacial sex differences have been extensively studied in humans, relatively little is known about when various dimorphic features manifest during postnatal life. Using cross-sectional data derived from the 3D Facial Norms data repository, we tested for sexual dimorphism of craniofacial soft-tissue morphology at different ages. Methods One thousand five hundred fifty-five individuals, pre-screened for craniofacial conditions, between 3 and 25 years of age were placed in to one of six age-defined categories: early childhood, late childhood, puberty, adolescence, young adult, and adult. At each age group, sex differences were tested by ANCOVA for 29 traditional soft-tissue anthropometric measurements collected from 3D facial scans. Additionally, sex differences in shape were tested using a geometric morphometric analysis of 24 3D facial landmarks. Results Significant (p < 0.05) sex differences were observed in every age group for measurements covering multiple aspects of the craniofacial complex. The magnitude of the dimorphism generally increased with age, with large spikes in the nasal, cranial, and facial measurements observed after puberty. Significant facial shape differences (p < 0.05) were also seen at each age, with some dimorphic features already present in young children (eye fissure inclination) and others emerging only after puberty (mandibular position). Conclusions Several craniofacial soft-tissue sex differences were already present in the youngest age group studied, indicating that these differences emerged prior to 3 years of age. The results paint a complex and heterogeneous picture, with different groups of traits exhibiting distinct patterns of dimorphism during ontogeny. The definitive adult male and female facial shape was present following puberty, but arose from numerous distinct changes taking place at earlier stages. Electronic supplementary material The online version of this article (doi:10.1186/s13293-016-0076-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Kesterke
- Department of Anthropology, University of Pittsburgh, Pittsburgh, PA USA
| | - Zachary D Raffensperger
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, 100 Technology Drive, Suite 500, Pittsburgh, PA 15219 USA
| | - Carrie L Heike
- Department of Pediatrics, University of Washington, Seattle, WA USA
| | - Michael L Cunningham
- Department of Pediatrics, University of Washington, Seattle, WA USA ; Department of Biological Structure, University of Washington, Seattle, WA USA ; Department of Oral Biology, University of Washington, Seattle, WA USA ; Department of Pediatric Dentistry, University of Washington, Seattle, WA USA
| | - Jacqueline T Hecht
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX USA
| | - Chung How Kau
- Department of Orthodontics, University of Alabama, Birmingham, AL USA
| | - Nichole L Nidey
- Department of Pediatrics, University of Iowa, Iowa City, IA USA
| | - Lina M Moreno
- Department of Orthodontics, University of Iowa, Iowa City, IA USA ; Dows Institute for Dental Research, University of Iowa, Iowa City, IA USA
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA USA
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, 100 Technology Drive, Suite 500, Pittsburgh, PA 15219 USA ; Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA USA ; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA ; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Seth M Weinberg
- Department of Anthropology, University of Pittsburgh, Pittsburgh, PA USA ; Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, 100 Technology Drive, Suite 500, Pittsburgh, PA 15219 USA
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Birgfeld CB, Heike CL, Saltzman BS, Leroux BG, Evans KN, Luquetti DV. Reliable classification of facial phenotypic variation in craniofacial microsomia: a comparison of physical exam and photographs. Head Face Med 2016; 12:14. [PMID: 27029551 PMCID: PMC4815065 DOI: 10.1186/s13005-016-0109-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/16/2016] [Indexed: 01/19/2023] Open
Abstract
Background Craniofacial microsomia is a common congenital condition for which children receive longitudinal, multidisciplinary team care. However, little is known about the etiology of craniofacial microsomia and few outcome studies have been published. In order to facilitate large, multicenter studies in craniofacial microsomia, we assessed the reliability of phenotypic classification based on photographs by comparison with direct physical examination. Methods Thirty-nine children with craniofacial microsomia underwent a physical examination and photographs according to a standardized protocol. Three clinicians completed ratings during the physical examination and, at least a month later, using respective photographs for each participant. We used descriptive statistics for participant characteristics and intraclass correlation coefficients (ICCs) to assess reliability. Results The agreement between ratings on photographs and physical exam was greater than 80 % for all 15 categories included in the analysis. The ICC estimates were higher than 0.6 for most features. Features with the highest ICC included: presence of epibulbar dermoids, ear abnormalities, and colobomas (ICC 0.85, 0.81, and 0.80, respectively). Orbital size, presence of pits, tongue abnormalities, and strabismus had the lowest ICC, values (0.17 or less). There was not a strong tendency for either type of rating, physical exam or photograph, to be more likely to designate a feature as abnormal. The agreement between photographs and physical exam regarding the presence of a prior surgery was greater than 90 % for most features. Conclusions Our results suggest that categorization of facial phenotype in children with CFM based on photographs is reliable relative to physical examination for most facial features.
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Affiliation(s)
- Craig B Birgfeld
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA.,Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Carrie L Heike
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA. .,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA. .,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA.
| | - Babette S Saltzman
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Brian G Leroux
- Department of Biostatistics, School of Public Health and Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Kelly N Evans
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA
| | - Daniela V Luquetti
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington, M/S OB.9.520, PO Box 5371 4800 Sand Point Way, Seattle, WA, 98105, USA.,Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA, USA
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Weinberg SM, Raffensperger ZD, Kesterke MJ, Heike CL, Cunningham ML, Hecht JT, Kau CH, Murray JC, Wehby GL, Moreno LM, Marazita ML. The 3D Facial Norms Database: Part 1. A Web-Based Craniofacial Anthropometric and Image Repository for the Clinical and Research Community. Cleft Palate Craniofac J 2015; 53:e185-e197. [PMID: 26492185 DOI: 10.1597/15-199] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
With the current widespread use of three-dimensional (3D) facial surface imaging in clinical and research environments, there is a growing demand for high-quality craniofacial norms based on 3D imaging technology. The principal goal of the 3D Facial Norms (3DFN) project was to create an interactive, Web-based repository of 3D facial images and measurements. Unlike other repositories, users can gain access to both summary-level statistics and individual-level data, including 3D facial landmark coordinates, 3D-derived anthropometric measurements, 3D facial surface images, and genotypes from every individual in the dataset. The 3DFN database currently consists of 2454 male and female participants ranging in age from 3 to 40 years. The subjects were recruited at four US sites and screened for a history of craniofacial conditions. The goal of this article is to introduce readers to the 3DFN repository by providing a general overview of the project, explaining the rationale behind the creation of the database, and describing the methods used to collect the data. Sex- and age-specific summary statistics (means and standard deviations) and growth curves for every anthropometric measurement in the 3DFN dataset are provided as a supplement available online. These summary statistics and growth curves can aid clinicians in the assessment of craniofacial dysmorphology.
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Luquetti DV, Saltzman BS, Heike CL, Sie KC, Birgfeld CB, Evans KN, Leroux BG. Phenotypic sub-grouping in microtia using a statistical and a clinical approach. Am J Med Genet A 2015; 167A:688-94. [PMID: 25655944 DOI: 10.1002/ajmg.a.36963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/21/2014] [Indexed: 11/08/2022]
Abstract
The clinical presentation of microtia varies widely from minimal morphological abnormalities to complete absence of the ear. In this study we sought to identify and characterize sub-groups of microtia using a statistical and a clinical approach. Photographs of 86 ears were classified in relation to all the external ear components. We used cluster analysis and rater's clinical opinion to identify groups with similar phenotypes in two separate analyses. We used Cramer's Phi coefficient of association to assess the similarity among the clinician's groupings as well as among the statistical sub-phenotypic groups and each of the clinician's groupings. The cluster analysis initially divided the 86 ears into a more and a less severe group. The less severe group included two sub-groups that included ears classified as normal and a group that had very few anomalous components. The group of 48 more affected ears all had abnormalities of the helix crus; antihelix-stem, -superior crus and -inferior crus; and antitragus. These were further divided into 4 sub-phenotypes. There was a moderate degree of association among the raters' groupings (Cramer's Phi: 0.64 to 0.73). The statistical and clinical groupings had a lower degree of association (Cramer's Phi: 0.49 to 0.58). Using standardized characterization of structural abnormalities of the ear we identified six distinct phenotypic groups; correlations with clinicians' groupings were moderate. These clusters may represent groups of ear malformations associated with the same etiology, similar time of insult or target cell population during embryonic development. The results will help inform investigations on etiology.
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Affiliation(s)
- Daniela V Luquetti
- Department of Pediatrics, University of Washington, Seattle, Washington; Craniofacial Center, Seattle Children's Hospital, Seattle, Washington; Center of Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, Seattle, Washington
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Wang KH, Heike CL, Clarkson MD, Mejino JLV, Brinkley JF, Tse RW, Birgfeld CB, Fitzsimons DA, Cox TC. Evaluation and integration of disparate classification systems for clefts of the lip. Front Physiol 2014; 5:163. [PMID: 24860508 PMCID: PMC4030199 DOI: 10.3389/fphys.2014.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/09/2014] [Indexed: 12/15/2022] Open
Abstract
Orofacial clefting is a common birth defect with wide phenotypic variability. Many systems have been developed to classify cleft patterns to facilitate diagnosis, management, surgical treatment, and research. In this review, we examine the rationale for different existing classification schemes and determine their inter-relationships, as well as strengths and deficiencies for subclassification of clefts of the lip. The various systems differ in how they describe and define attributes of cleft lip (CL) phenotypes. Application and analysis of the CL classifications reveal discrepancies that may result in errors when comparing studies that use different systems. These inconsistencies in terminology, variable levels of subclassification, and ambiguity in some descriptions may confound analyses and impede further research aimed at understanding the genetics and etiology of clefts, development of effective treatment options for patients, as well as cross-institutional comparisons of outcome measures. Identification and reconciliation of discrepancies among existing systems is the first step toward creating a common standard to allow for a more explicit interpretation that will ultimately lead to a better understanding of the causes and manifestations of phenotypic variations in clefting.
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Affiliation(s)
- Kathie H Wang
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute Seattle, WA, USA
| | - Carrie L Heike
- Center for Clinical and Translational Sciences, Seattle Children's Research Institute Seattle, WA, USA ; Seattle Children's Craniofacial Center Seattle, WA, USA ; Department of Pediatrics (Division of Craniofacial Medicine), University of Washington Seattle, WA, USA
| | - Melissa D Clarkson
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA ; Department of Biomedical Informatics and Medical Education, University of Washington Seattle, WA, USA
| | - Jose L V Mejino
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA
| | - James F Brinkley
- Department of Biological Structure (Structural Informatics Group), University of Washington Seattle, WA, USA ; Department of Biomedical Informatics and Medical Education, University of Washington Seattle, WA, USA
| | - Raymond W Tse
- Seattle Children's Craniofacial Center Seattle, WA, USA
| | | | - David A Fitzsimons
- Faculty of Medicine, The Cleft Palate Clinic, The Children's Hospital at Westmead, and Discipline of Paediatrics and Child Health, University of Sydney Sydney, NSW, Australia
| | - Timothy C Cox
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute Seattle, WA, USA ; Seattle Children's Craniofacial Center Seattle, WA, USA ; Department of Pediatrics (Division of Craniofacial Medicine), University of Washington Seattle, WA, USA ; Department of Anatomy and Developmental Biology, Monash University Clayton, VIC, Australia
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Atmosukarto I, Shapiro LG, Starr JR, Heike CL, Collett B, Cunningham ML, Speltz ML. Three-dimensional head shape quantification for infants with and without deformational plagiocephaly. Cleft Palate Craniofac J 2014; 47:368-77. [PMID: 20590458 DOI: 10.1597/09-059.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The authors developed and tested three-dimensional (3D) indices for quantifying the severity of deformational plagiocephaly (DP). DESIGN The authors evaluated the extent to which infants with and without DP (as determined by clinic referral and two experts' ratings) could be correctly classified. PARTICIPANTS Infants aged 4 to 11 months, including 154 with diagnosed DP and 100 infants without a history of DP or other craniofacial condition. After excluding participants with discrepant expert ratings, data from 90 infants with DP and 50 infants without DP were retained. MEASUREMENTS Two-dimensional (2D) histograms of surface normal vector angles were extracted from 3D mesh data and used to compute the severity scores. OUTCOME MEASURES Left posterior flattening score (LPFS), right posterior flattening score (RPFS), asymmetry score (AS), absolute asymmetry score (AAS), and an approximation of a previously described 2D measure, the oblique cranial length ratio (aOCLR). Two-dimensional histograms localized the posterior flatness for each participant. ANALYSIS The authors fit receiver operating characteristic curves and calculated the area under the curves (AUC) to evaluate the relative accuracy of DP classification using the above measures. RESULTS The AUC statistics were AAS = 91%, LPFS = 97%, RPFS = 91%, AS = 99%, and aOCLR = 79%. CONCLUSION Novel 3D-based plagiocephaly posterior severity scores provided better sensitivity and specificity in the discrimination of plagiocephalic and typical head shapes than the 2D measurements provided by a close approximation of OCLR. These indices will allow for more precise quantification of the DP phenotype in future studies on the prevalence of this condition, which may lead to improved clinical care.
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Affiliation(s)
- I Atmosukarto
- Department of Computer Science and Engineering, University of Washington, Seattle, USA
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Heike CL, Hing AV, Aspinall CA, Bartlett SP, Birgfeld CB, Drake AF, Pimenta LA, Sie KC, Urata MM, Vivaldi D, Luquetti DV. Clinical care in craniofacial microsomia: a review of current management recommendations and opportunities to advance research. Am J Med Genet C Semin Med Genet 2013; 163C:271-82. [PMID: 24132932 DOI: 10.1002/ajmg.c.31373] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Craniofacial microsomia (CFM) is a complex condition associated with microtia, mandibular hypoplasia, and preauricular tags. It is the second most common congenital facial condition treated in many craniofacial centers and requires longitudinal multidisciplinary patient care. The purpose of this article is to summarize current recommendations for clinical management and discuss opportunities to advance clinical research in CFM.
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Brinkley JF, Borromeo C, Clarkson M, Cox TC, Cunningham MJ, Detwiler LT, Heike CL, Hochheiser H, Mejino JLV, Travillian RS, Shapiro LG. The ontology of craniofacial development and malformation for translational craniofacial research. Am J Med Genet C Semin Med Genet 2013; 163C:232-45. [PMID: 24124010 DOI: 10.1002/ajmg.c.31377] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We introduce the Ontology of Craniofacial Development and Malformation (OCDM) as a mechanism for representing knowledge about craniofacial development and malformation, and for using that knowledge to facilitate integrating craniofacial data obtained via multiple techniques from multiple labs and at multiple levels of granularity. The OCDM is a project of the NIDCR-sponsored FaceBase Consortium, whose goal is to promote and enable research into the genetic and epigenetic causes of specific craniofacial abnormalities through the provision of publicly accessible, integrated craniofacial data. However, the OCDM should be usable for integrating any web-accessible craniofacial data, not just those data available through FaceBase. The OCDM is based on the Foundational Model of Anatomy (FMA), our comprehensive ontology of canonical human adult anatomy, and includes modules to represent adult and developmental craniofacial anatomy in both human and mouse, mappings between homologous structures in human and mouse, and associated malformations. We describe these modules, as well as prototype uses of the OCDM for integrating craniofacial data. By using the terms from the OCDM to annotate data, and by combining queries over the ontology with those over annotated data, it becomes possible to create "intelligent" queries that can, for example, find gene expression data obtained from mouse structures that are precursors to homologous human structures involved in malformations such as cleft lip. We suggest that the OCDM can be useful not only for integrating craniofacial data, but also for expressing new knowledge gained from analyzing the integrated data.
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Birgfeld CB, Saltzman BS, Luquetti DV, Latham K, Starr JR, Heike CL. Comparison of Two-Dimensional and Three-Dimensional Images for Phenotypic Assessment of Craniofacial Microsomia. Cleft Palate Craniofac J 2013; 50:305-14. [DOI: 10.1597/11-173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Purpose Three-dimensional surface imaging is used in many craniofacial centers. However, few data exist to indicate whether such systems justify their cost. Craniofacial microsomia is associated with wide phenotypic variability and can affect most facial features. The purpose of this study is to compare three-dimensional versus two-dimensional images for classification of facial features in individuals with craniofacial microsomia. Methods We obtained a series of two-dimensional and three-dimensional images of 50 participants, aged 0-20 years, diagnosed with craniofacial microsomia, microtia, or Goldenhar syndrome. Three clinicians classified the craniofacial features on each image, and ratings were compared by calculating kappa statistics. We also evaluated image quality using a 5-point Likert scale. Results Reliability estimates were high for most features using both two-dimensional and three-dimensional image data. Our three-dimensional protocol did not allow for scoring of facial animation, occlusal cant, or tongue anomalies. Image quality scores for the mandible and soft tissue assessment were higher for three-dimensional images. Raters preferred two-dimensional photographs for assessment of the ear, ear canal, and eyes. Conclusions Both three-dimensional and two-dimensional images provide useful data for objective characterization of the craniofacial features affected in craniofacial microsomia. A series of two-dimensional images has relative advantages for assessment of some specific features, such as the ear, though three-dimensional images may have advantages for quantitative analysis and qualitative assessment of deformities of the jaw and soft tissue. These results should apply to any assessment of these features with or without a craniofacial microsomia diagnosis.
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Affiliation(s)
- Craig B. Birgfeld
- Division of Plastic Surgery, Department of Surgery, University of Washington, and Seattle Children's Hospital, Bethesda, Maryland
| | | | | | - Kerry Latham
- Walter Reed Hospital, Military Medical Center, Bethesda, Maryland
| | | | - Carrie L. Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, and Seattle Children's Hospital, Seattle, Washington
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Luquetti DV, Saltzman BS, Sie KC, Birgfeld CB, Leroux BG, Evans KN, Smartt JM, Tieu DD, Dudley DJ, Heike CL. Interrater reliability of a phenotypic assessment tool for the ear morphology in microtia. Am J Med Genet A 2013; 161A:1264-72. [PMID: 23616389 DOI: 10.1002/ajmg.a.35963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/04/2013] [Indexed: 11/05/2022]
Abstract
The Elements of Morphology Standard Terminology working group published standardized definitions for external ear morphology. The primary objective of our study was to use these descriptions to evaluate the interrater reliability for specific features associated with microtia. We invited six raters from three different subspecialities to rate 100 ear photographs on 32 features. We calculated overall and within specialty and professional experience intraclass correlation coefficients (ICC) and 95% confidence intervals. A total of 600 possible observations were recorded for each feature. The overall interrater reliability ranged from 0.04 (95% CI: 0.00-0.14) for the width of the antihelix inferior crus to 0.93 (95% CI: 0.91-0.95) for the presence of the inferior crux of the antihelix. The reliability for quantitative characteristics such as length or width of an ear structure was generally lower than the reliability for qualitative characteristics (e.g., presence or absence of an ear structure). Categories with very poor interrater reliability included anti-helix inferior crux width (0.04, 95% CI: 0.00-0.14), crux helix extension (0.17, 95% CI 0.00-0.37), and shape of the incisura (0.14, 95% CI: 0.01-0.27). There were no significant differences in reliability estimates by specialty or professional experience for most variables. Our study showed that it is feasible to systematically characterize many of structures of the ear that are affected in microtia. We incorporated these descriptions into a standardized phenotypic assessment tool (PAT-Microtia) that might be used in multicenter research studies to identify sub-phenotypes for future studies of microtia.
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Affiliation(s)
- Daniela V Luquetti
- Department of Pediatrics, University of Washington, and Craniofacial Center, Seattle Children's Hospital, Seattle, Washington 98101, USA.
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Parsons TE, Raffensperger ZD, Hecht JT, Heike CL, Cunningham ML, Marazita ML, Weinberg SM. Shape Analysis of the Facebase 3D Facial Norms Dataset Reveals Sexual Dimorphism in Human Faces in Juveniles, Adolescents and Adults. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.519.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Carrie L Heike
- PediatricsUniversity of WashingtonSeattleWA
- PediatricsSeattle Children'sSeattleWA
| | - Michael L Cunningham
- PediatricsUniversity of WashingtonSeattleWA
- PediatricsSeattle Children'sSeattleWA
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Abstract
OBJECTIVES Infants and toddlers with deformational plagiocephaly (DP) have been shown to score lower on developmental measures than unaffected children. To determine whether these differences persist, we examined development in 36-month-old children with and without a history of DP. METHODS Participants included 224 children with DP and 231 children without diagnosed DP, all of who had been followed in a longitudinal study since infancy. To confirm the presence or absence of DP, pediatricians blinded to children's case status rated 3-dimensional cranial images taken when children were 7 months old on average. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was administered as a measure of child development. RESULTS Children with DP scored lower on all scales of the BSID-III than children without DP. Differences were largest in cognition, language, and parent-reported adaptive behavior (adjusted differences = -2.9 to -4.4 standard score points) and smallest in motor development (adjusted difference = -2.7). Children in the control group who did not have previously diagnosed DP but who were later rated by pediatricians to have at least mild cranial deformation also scored lower on the BSID-III than unaffected controls. CONCLUSIONS Preschool-aged children with a history of DP continue to receive lower developmental scores than unaffected controls. These findings do not imply that DP causes developmental problems, but DP may nonetheless serve as a marker of developmental risk. We encourage clinicians to screen children with DP for developmental concerns to facilitate early identification and intervention.
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Affiliation(s)
- Brent R. Collett
- Departments of Psychiatry and Behavioral Sciences,,Department of Psychiatry and Behavioral Medicine, and
| | | | - Jacqueline R. Starr
- Epidemiology, and,Department of Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts; and,Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Carrie L. Heike
- Pediatrics, University of Washington, Seattle, Washington;,Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
| | - Michael L. Cunningham
- Pediatrics, University of Washington, Seattle, Washington;,Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
| | - Matthew L. Speltz
- Departments of Psychiatry and Behavioral Sciences,,Department of Psychiatry and Behavioral Medicine, and
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