Evaluation of the Molding Helmet Therapy for Japanese Infants with Deformational Plagiocephaly

Abstract

Introduction: Deformational plagiocephaly (DP) is cranial flattening on one side of the back of the skull produced by an extrinsic force on the intrinsically normal skull. When the flattening is symmetrical, the deformity is called deformational brachycephaly (DB). In the US, its prevalence has increased since the “Back to Sleep” campaign by the American Association of Pediatrics. Helmet therapy is reported to be effective in improving head deformity by multiple studies, but there are few evidences from Japan. The purpose of this study is to investigate the safety and efficacy of helmet therapy for DP, and the feasibility of introducing this treatment to the clinical setting in Japan. Methods: This was a single-arm, retrospective, nonrandomized study. Data were collected on infants who visited the “Clinic for Baby’s Head Shape” in the National Center for Child Health and Development, Tokyo, Japan, between 2011 and 2014. Improvements in Argenta classification, cranial asymmetry (CA), and cranial vault asymmetry index (CVAI) were evaluated. The relationships between CA and influencing factors were evaluated using a linear mixed-effects model. Results: Three hundred eighty-seven infants (273 boys and 114 girls; average age, 4.7 months) visited the clinic during the period, and 159 patients who completed the helmet therapy were analyzed. There were statistically significant improvements in Argenta classification, CA, and CVAI. Almost all of the parents reported increased sweating and mild skin irritation, but no adverse events necessitated the cessation of helmet therapy, except for one patient with increased sweating. Conclusions: Helmet therapy is safe and effective in treating DP and is feasible to introduce to the clinical setting in Japan. Through the distribution of knowledge regarding the etiology and treatment of head deformity, earlier detection and an evidence-based approach to head deformity are expected in the future.

Sutures ultrasound: useful diagnostic screening for posterior plagiocephaly

“…Classically, the anomaly is distinct in synostotic and not, the latter noted also as positional plagiocephaly (PP). PP is linked to intrinsic factors and intrauterine constraints as happens with multiple births, large size for gestational age, oligohydramnios, breech and transverse position, and congenital torticollis [26]. Preterm births are particularly at risk of PP, and there is an inverse correlation between preterm age and PP risk [2].…”

“…Causes are the soft skull and placement within the thermal cradle. PP is a selflimiting clinical condition, where timely cranial osteopathy favors the resolution of the anomaly with early treatment [25,26]. In these cases, the head assumes the typical flattened shape posteriorly, or brachycephaly.…”

Cranial Shape in Infants Aged One Month Can Predict the Severity of Deformational Plagiocephaly at the Age of Six Months

“…The cranial asymmetry (CA) and cranial vault asymmetry index (CVAI) referred to the measurements of the differences between the longer and shorter diagonals at the level of the measurement plane at 30° from the Y-axis with regard to the length of the longer diagonal (CA = length of the longer diagonal − length of the shorter diagonal (mm); CVAI = (longer diagonal—shorter diagonal)/shorter diagonal (%)) [ 15 ]. Although the diagnostic criterion for DP is internationally defined as a CVAI > 3.5% [ 15 , 16 , 17 ], in a previous report from Japan [ 5 ]—where the prevalence of DP is higher than that of other countries—the diagnostic criterion for DP was set at a CVAI > 5% [ 5 ]. In our present study, a CVAI > 5% was also set as the diagnostic criterion for DP; the DP severity was classified as: mild, 5.00 to 6.25%; moderate, 6.25 to 8.75%; severe, 8.75–11%; and very severe, >11% [ 7 , 17 ].…”

“…Cranial helmet therapy (CHT) for DP was introduced in the 2000s and has yielded good outcomes in Japan [ 4 , 5 , 6 ]. It is recommended that CHT for DP is initiated at 3–6 months of age [ 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…Cranial helmet therapy (CHT) for DP was introduced in the 2000s and has yielded good outcomes in Japan [ 4 , 5 , 6 ]. It is recommended that CHT for DP is initiated at 3–6 months of age [ 4 , 5 , 6 , 7 , 8 , 9 ]. A delay in starting CHT is often encountered because DP can be improved in several cases by repositioning the infant.…”