The natural history of chronic hepatitis B in children is influenced by mode of transmission and varies with regional endemicity. Seroconversion rates were studied in 174 hepatitis B e antigen (HBeAg)-positive children who were of different ethnic origins and living in Canada. Overall, 40.2% became anti-HBeAg positive, and 8.6% were hepatitis B surface-antigen positive during a mean follow-up of 4.5 years. Spontaneous seroconversion rates were lower in Asian-born, mainly vertically infected, children, versus those born either in Canada or where horizontal transmission predominates (24% vs. 44%, P=.015). Kaplan-Meier analysis showed that the cumulative persistence of HBeAg after 13 years was 25% in Asian-born children, versus 6% in all others (P<.05). Treatment of 27 children accelerated seroconversion by 3 years, without influencing the proportion seroconverting over time. Thus, although Asian-born children seroconvert more slowly, a large proportion will seroconvert before adulthood. Because treatment appears to accelerate anti-HBe seroconversion, longitudinal studies are required in order to assess the long-term benefits of early treatment.

We compared health status, anthropometric and psychological development of 123 children adopted before 18 months of age from China, East Asia (Vietnam, Taiwan, Thailand, South Korea, Cambodia), and Eastern Europe (mostly Russia). Data were collected close to the time of arrival, and 3 and 6 months later. Anthropometric measures included weight, height, and head circumference percentiles, and weight/height and height/age ratios (indices of acute and chronic malnutrition, respectively). We assessed cognitive (MDI) and motor (PDI) developments with the Bayley Scales of Infant Development (Bayley, 1993). At time of arrival, children presented physical, cognitive, and motor delays, as well as health problems. Growth parameters improved with time, but differently among the groups. East Asian children, in a better physical state at time of arrival, changed less than the others did across time. Children adopted from Russia globally had lower MDI than the others, while children adopted from East Asia had the highest PDI. Hierarchical linear modelling indicated that initial MDI was related to height/age ratio (index of chronic malnutrition), while its change over time was related to age at time of arrival. PDI was also related to height/age ratio, as well as to presence/absence of neurological signs at time of arrival. Infants with a higher risk index had lower MDI and PDI initial scores.

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