寄养和机构照料中的罗马尼亚儿童，其早期青春期的生长和青春期发育会受到照护中断的影响：一项随机临床试验。
Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial.
机构信息
Division of Neonatology and Global Pediatrics, Department of Pediatrics, University of Minnesota Medical School, Minnesota, MN.
Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD.
出版信息
J Pediatr. 2018 Dec;203:345-353.e3. doi: 10.1016/j.jpeds.2018.07.027. Epub 2018 Aug 29.
OBJECTIVES
To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence.
STUDY DESIGN
This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized control children living in birth families (family care group) in Bucharest, Romania. Children were followed from baseline (21 months, range 5-31) through age 12 years for caregiving disruptions and growth trajectories and through age 14 years for pubertal development.
RESULTS
Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group. Tanner development was delayed in institutionalized group boys compared with foster care group and family care group boys at 12 but not 14 years. There were no differences in Tanner development and age of menarche among foster care group, institutionalized group, and family care group girls at ages 12 and 14 years. More disruptions in caregiving between 30 months and 12 years moderated decreases in growth rates of height in foster care group and weight in foster care group and institutionalized group across age. institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 vs institutionalized group and foster care group boys with <2 disruptions. foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 vs foster care group girls with <2 disruptions. Age of menarche was not affected by caregiving disruptions.
CONCLUSIONS
For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental.
TRIAL REGISTRATION
clinicaltrials.gov: NCT00747396.
目的
通过早期青春期研究，确定寄养与机构照料以及照料环境中断对体格发育的影响。
研究设计
这是一项在罗马尼亚布加勒斯特的 6 家孤儿院的 114 名被机构收养但健康的儿童和 51 名从未被机构收养的对照组儿童（家庭护理组）中进行的随机对照试验。这些儿童从基线（21 个月，范围 5-31 个月）开始随访，直到 12 岁时评估照料中断和生长轨迹，14 岁时评估青春期发育情况。
结果
随机分配到寄养组的儿童在 12 岁前身高、体重和体重指数（BMI）的生长速度均高于机构组。与寄养组和家庭护理组男孩相比，机构组男孩的青春期发育延迟，在 12 岁时出现，但在 14 岁时没有。在 12 岁和 14 岁时，寄养组、机构组和家庭护理组女孩的青春期发育和初潮年龄没有差异。30 个月至 12 岁期间照料中断次数较多会降低寄养组和机构组儿童的身高和体重增长率。机构组男孩如果有≥2 次照料中断，其在 12 岁时的 Tanner 评分会低于有 <2 次照料中断的机构组和寄养组男孩。有≥2 次照料中断的寄养组女孩在 14 岁时的 Tanner 评分会高于有 <2 次照料中断的寄养组女孩。初潮年龄不受照料中断的影响。
结论
对于那些经历过早期机构化的儿童来说，在家庭护理中获得稳定的安置对于确保最佳的体格发育结果至关重要。
试验注册
clinicaltrials.gov：NCT00747396。
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