Open Access Study protocol

Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149]

George L Wehby1, Eduardo E Castilla23, Norman Goco4, Monica Rittler5, Viviana Cosentino2, Lorette Javois6, Ann Marie McCarthy7, Georgiy Bobashev4, Stephen Litavecz4, Alejandra Mariona2, Graca Dutra3, Jorge S López-Camelo8, Iêda M Orioli9 and Jeffrey C Murray10*

Author Affiliations

1 Department of Health Management and Policy, University of Iowa, Iowa City, USA

2 Latin American Collaborative Study of Congenital Malformations (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina

3 ECLAMC, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil

4 RTI International, Research Triangle Park, USA

5 ECLAMC, Maternidad Ramón Sardá, Buenos Aires, Argentina

6 Center for Developmental Biology and Perinatal Medicine, National Institute of Child Health and Human Development, Bethesda, USA

7 College of Nursing, University of Iowa, Iowa City, USA

8 ECLAMC, Instituto Multidisciplinario de Biologia Celular (IMBICE), La Plata, Argentina

9 ECLAMC, Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

10 Department of Pediatrics, University of Iowa, Iowa City, USA

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BMC Pediatrics 2006, 6:9  doi:10.1186/1471-2431-6-9

Published: 24 March 2006



The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally.


We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions.


Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan their studies more effectively and encourage the development of similar research efforts to target other birth defects or infant outcomes such as prematurity and low birth weight.