Head Growth and Neurocognitive Outcomes
Head Growth and Neurocognitive Outcomes
复制标题
头部生长和神经认知结果
作者：
C. Wright;A. Emond
背景和证据：头围（HC）作为筛查指标的价值缺乏证据。我们的目的是描述发生率的头部百分位数移动和极端的头部大小和后来的神经发育问题之间的关系，在雅芳纵向研究的父母和孩子。方法：HC在2、9、18或24个月时进行常规测量，研究人员在4、8、12和18个月时进行测量。根据韦氏儿童智力量表，所有儿童在8岁时在研究诊所进行智商测量。通过病历审查确定神经认知障碍（NCD）。结果：有10851名儿童有≥2个头部测量值。在每个年龄段，2%至3%的儿童的得分低于或高于平均值<-2或>2 SD，但对于大多数儿童来说，这只在1岁时发现。超过15%的儿童表现出百分位数的变化，但在随后的测量中，只有不到三分之一的变化持续存在。只有0.5%的人表现出超出正常范围的持续变化。头部始终较小的儿童患非传染性疾病的可能性高达7倍，但85%的头部较小的儿童没有非传染性疾病，93%的非传染性疾病儿童的头部SD评分在正常范围内。结论：正常范围内的百分位数变化很常见，似乎主要反映了测量误差。这一发现使得对头部轨迹的可靠评估变得困难，并可能导致许多儿童受到不必要的调查。极端的头部尺寸对于检测NCD既不特异也不敏感，这表明常规测量HC是没有帮助的。
BACKGROUND AND OBJECTIVES: There is a lack of evidence on the value of head circumference (HC) as a screening measure. We aimed to describe the incidence of head centile shifting and the relationship between extremes of head size and later neurodevelopmental problems in the Avon Longitudinal Study of Parents and Children. METHODS: HC was measured routinely at 2, 9, and 18 or 24 months and by researchers at ages 4, 8, 12, and 18 months. IQ according to the Wechsler Intelligence Scale for Children was measured in research clinics at age 8 for all. Neurocognitive disorders (NCDs) were identified from chart review. RESULTS: There were 10 851 children with ≥2 head measurements. At each age, 2% to 3% of children had scores that were < −2 or >2 SDs below or above the mean, but for most children this was only found at 1 age. More than 15% of children showed centile shifts, but less than one-third of these were sustained at subsequent measurements. Only 0.5% showed a sustained shift beyond the normal range. Children with consistently small heads were up to 7 times more likely to have an NCD, but 85% of children with small heads had no NCDs, and 93% of children with NCDs had head SD scores within the normal range. CONCLUSIONS: Centile shifts within the normal range occur commonly and seem mainly to reflect measurement error. This finding makes robust assessment of the head trajectory difficult and may result in many children being investigated unnecessarily. Extreme head size is neither specific nor sensitive for detecting NCDs, suggesting that routine measurement of HC is unhelpful.