Case-Control Study of Neurodevelopment in Deformational Plagiocephaly

Speltz, Matthew L.; Collett, Brent R.; Stott-Miller, Marni; Starr, Jacqueline R.; Heike, Carrie L.; Wolfram-Aduan, Antigone M.; King, Darcy; Cunningham, Michael L.

doi:10.1542/peds.2009-0052

Cited by 106 publications

(104 citation statements)

References 14 publications

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“…15,27,68 Other studies have proposed obstetric concerns such as constraints of the birth canal on firstborn babies, prolonged labor, breech position, assisted deliveries, intrauterine restrictions, and plural births. 39,54,63 The impact of supine sleeping position on PP is best illustrated by the AAP's 1992 recommendation for infants to sleep on their backs. 1 This BTS campaign decreased the incidence of SIDS by more than 40%, but increased consultations for PP by 600%.…”

Section: Established Risk Factorsmentioning

confidence: 99%

“…39,46 More recently, however, studies have built a possible association between disruptions in infant development and PP. 10,21,28,30,63 Multiple reports over the past decade have pointed to links between PP and abnormal ophthalmological findings, auditory processing, and motor development. 4,10,25,27,28,35,44,47,62,63,68 Two case-controlled studies, by Speltz et al 63 and Fowler et al, 21 found significant variability in gross motor development and body tone.…”

Section: Established Risk Factorsmentioning

confidence: 99%

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Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

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Object Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed. Methods A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects. Results Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed. Conclusions Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.

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Section: Established Risk Factorsmentioning

confidence: 99%

Section: Established Risk Factorsmentioning

confidence: 99%

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Shweikeh

Nuño

Danielpour

et al. 2013

FOC

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“…Greater numbers of studies are confirming the correlation between positional plagiocephaly and neurodevelopmental delay seen in fine motor skills. 7,9,12,19 Whether the developmental delay or the plagiocephaly is the causative factor remains unanswered. The importance of regular repositioning and observed tummy time cannot be overstated.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

Couture¹,

Crantford

Somasundaram³

et al. 2013

FOC

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Object There has been a tremendous increase in the incidence of deformational plagiocephaly in children throughout the world. Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. The current treatment in the US is highly debated, but it typically includes external orthotic helmets in patients with moderate to severe plagiocephaly presenting between 4 and 10 months of age or in children with significant comorbidities limiting passive (no-pressure) therapy. The present study was designed to evaluate 3 key issues: 1) the accuracy of the Argenta classification in defining a progressive degree of severity, 2) identification of an upper age limit when treatment is no longer effective, and 3) the effectiveness of an off-the-shelf prefabricated helmet in correcting deformational plagiocephaly. Methods An institutional review board–approved retrospective study was conducted of all patients at the authors' clinic in whom deformational plagiocephaly was assessed using the Argenta classification system over a 6-year period; the patients underwent helmet therapy, and a minimum of 3 clinic visits were recorded. Inclusion criteria consisted of an Argenta Type II–V plagiocephalic deformity. Patients' conditions were categorized both by severity of the deformity and by patients' age at presentation. Statistical analysis was conducted using survival analysis. Results There were 1050 patients included in the study. Patients with Type III, IV, and V plagiocephaly required progressively longer for deformity correction to be achieved than patients with Type II plagiocephaly (53%, 75%, and 81% longer, respectively [p < 0.0001]). This finding verified that the Argenta stratification indicated a progressive severity of deformity. No statistically significant difference in the time to correction was noted among the different age categories, which suggests that the previously held upper time limit for correction may be inaccurate. An overall correction rate to Type I plagiocephaly of 81.6% was achieved irrespective of severity and degree of the original deformity. This suggests that an inexpensive off-the-shelf molding helmet is highly effective and that expensive custom-fitted orthoses may not be necessary. The patients in the older age group (> 12 months) did not have a statistically significant longer interval to correction than the patients in the youngest age group (< 3 months). The mean length of follow-up was 6.3 months. Conclusions Patients treated with passive helmet therapy in the older age group (> 12 months) had an improvement in skull shape within the same treatment interval as the patients in the younger age group (< 3 months). This study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the stratification of degree of deformity used in the Argenta classification system.

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“…Deformational plagiocephaly was associated with a decrement in Bayley Scales of Infant Development scores (p < 0.001), most significantly evident in motor functions. 27 It is likely, however, that any difference in motor development between these 2 groups is simply due to spending less time in the prone position, and not due to the positional plagiocephaly. In addition to motor development, a 1259-patient retrospective study showed a trend correlating deformational plagiocephaly with otitis media, possibly because of plagiocephalic developmental alteration of the eustachian tube.…”

Section: Sequelaementioning

confidence: 97%

The sociopolitical history and physiological underpinnings of skull deformation

Ayer

Campbell

Appelboom

et al. 2010

FOC

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In this report, the evidence, mechanisms, and rationale for the practice of artificial cranial deformation (ACD) in ancient Peru and during Akhenaten's reign in the 18th dynasty in Egypt (1375–1358 BCE) are reviewed. The authors argue that insufficient attention has been given to the sociopolitical implications of the practice in both regions. While evidence from ancient Peru is widespread and complex, there are comparatively fewer examples of deformed crania from the period of Akhenaten's rule. Nevertheless, Akhenaten's own deformity, the skull of the so-called “Younger Lady” mummy, and Tutankhamen's skull all evince some degree of plagiocephaly, suggesting the need for further research using evidence from depictions of the royal family in reliefs and busts. Following the anthropological review, a neurosurgical focus is directed to instances of plagiocephaly in modern medicine, with special attention to the conditions' etiology, consequences, and treatment. Novel clinical studies on varying modes of treatment will also be studied, together forming a comprehensive review of ACD, both in the past and present.

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Case-Control Study of Neurodevelopment in Deformational Plagiocephaly

Cited by 106 publications

References 14 publications

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines

Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

The sociopolitical history and physiological underpinnings of skull deformation

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