Plagiocephaly and brachycephaly in the first two years of life: A prospective cohort study
Plagiocephaly and brachycephaly in the first two years of life: A prospective cohort study
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DOI：
10.1542/peds.2003-0668-f
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发表时间：
2004-10-01
期刊：
影响因子：
8
通讯作者：
Mitchell, EA
中科院分区：
文献类型：
--
作者：
Hutchison, BL;Hutchison, LAD;Mitchell, EA
目标。尽管近年来转诊的非融合性斜头症(NSP)有所增加，但这种疾病的患病率、自然病史和决定因素尚不清楚。本研究的目的是评估正常婴儿出生后2年内NSP的患病率和自然病史，并找出可能导致NSP发生的因素。200名婴儿在出生时被招募。在6周、4个月、8个月、12个月和2岁时，数码拍摄头围形状，并使用定制的软件进行头形量化。在每个年龄段，婴儿被归类为头指数大于或等于93%和/或斜颅长度比大于或等于106%的病例。对颈部旋转和一系列婴儿、婴儿护理、社会经济和产科因素进行评估。96%的婴儿随访至12个月，90.5%的婴儿随访至2年。在6周、4、8、12和24个月时，斜头畸形和/或短头畸形的患病率分别为16.0%、19.7%、9.2%、6.8%和3.3%。术后2年的平均头骨指数为81.6%(72.0%~102.6%)，平均斜颅长率为102.6%(100.1%~109.4%)。出生6周时NSP的显著单变量危险因素包括出生时有限的被动颈部旋转、偏头朝向、仰卧睡姿和入睡时头位不变。4个月时的危险因素为男性、头胎、出生时有限的被动转颈、4个月时有限的主动头部旋转、出生时和6周时仰卧睡眠、活动水平较低、在婴儿入睡时尝试改变头位失败。婴儿的头部形状多种多样，NSP的患病率增加到4个月，但随着婴儿年龄的增长，NSP的患病率下降。大多数案件将在两岁之前解决。有限的头部旋转、较低的活动量和仰卧睡眠姿势似乎是重要的决定因素。
Objectives. Although referrals for nonsynostotic plagiocephaly (NSP) have increased in recent years, the prevalence, natural history, and determinants of the condition have been unclear. The objective of this study was to assess the prevalence and natural history of NSP in normal infants in the first 2 years of life and to identify factors that may contribute to the development of NSP.Methods. Two hundred infants were recruited at birth. At 6 weeks, 4 months, 8 months, 12 months, and 2 years, the head circumference shape was digitally photographed, and head shape was quantified using custom-written software. At each age, infants were classified as cases when the cephalic index was greater than or equal to93% and/or the oblique cranial length ratio was greater than or equal to106%. Neck rotation and a range of infant, infant care, socioeconomic, and obstetric factors were assessed.Results. Ninety-six percent of infants were followed to 12 months, and 90.5% were followed to 2 years. Prevalence of plagiocephaly and/or brachycephaly at 6 weeks and 4, 8, 12, and 24 months was 16.0%, 19.7%, 9.2%, 6.8%, and 3.3% respectively. The mean cephalic index by 2 years was 81.6% (range: 72.0%-102.6%); the mean oblique cranial length ratio was 102.6% (range: 100.1%-109.4%). Significant univariate risk factors of NSP at 6 weeks include limited passive neck rotation at birth, preferential head orientation, supine sleep position, and head position not varied when put to sleep. At 4 months, risk factors were male gender, firstborn, limited passive neck rotation at birth, limited active head rotation at 4 months, supine sleeping at birth and 6 weeks, lower activity level, and trying unsuccessfully to vary the head position when putting the infant down to sleep.Conclusions. There is a wide range of head shapes in infants, and prevalence of NSP increases to 4 months but diminishes as infants grow older. The majority of cases will have resolved by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position seem to be important determinants.