Neurodevelopment Among Infants with Deformational Plagiocephaly

描述(申请人提供)：变形斜头症(DP)指的是颅骨不对称，据信是由于外力塑造了可塑婴儿的头骨。可疑的偶然因素包括产前因素(例如宫内约束)、产后事件(例如睡眠中的不变姿势)和/或潜在的神经病理。对患有痴呆症儿童的神经发育的初步研究发现了显著缺陷的证据，但方法问题限制了对这些研究的解释；对这些发现的潜在解释尚不清楚。进一步的研究是必要的，以完善病因假说，并为临床医生和父母提供关于DP的神经发育相关的准确信息。有几个因素表明有必要立即对这些问题进行研究：儿童发育迟缓率迅速上升(和/或家长对这种疾病的认识和担忧日益增加)，相关医疗手段(头盔和颅面外科手术)的普及，出现可预防的发育问题的可能性，以及与美国儿科学会“重返睡眠”运动之间的因果关系。在这项为期5年的纵向研究中，我们招募了300名患有DP的婴儿和325名匹配的对照组婴儿，从6个月到36个月进行跟踪调查，以调查这些问题。一组DP病例将使用MRI(n=46)进行成像，并通过与NIH资助的另一项正常大脑发育研究共享数据来与对照组进行比较。具体目标是：(1)使用神经心理发育的多领域模型比较患有和不患有DP的婴幼儿/幼儿的神经发育；(2)在患有DP的婴儿中，确定神经发育状况与颅骨不对称严重程度之间的关联(通过临床判断和头骨成像进行评估)；(3)建立和测试患有DP的婴儿36个月神经发育结果的预测模型；(4)评估患有和不患有DP的婴儿的感知面部外观(这种情况是否像许多父母担心的那样，对面部外观产生显著影响？)；(5)开发和测试父母参与选择性治疗的预测模型(即，哪些父母/家庭和婴儿的医疗因素最能预测治疗参与？)(6)应用MRI，比较患有和不患有DP的婴儿的脑结构和体积；在病例中，探讨脑结构/体积、颅骨不对称性和神经心理状态之间的关系。

DESCRIPTION (provided by applicant): Deformational plagiocephaly (DP) refers to cranial asymmetry believed to be attributable to external forces molding the malleable infant skull. Suspected casual factors include pre-natal factors (e.g., intrauterine constraint), post-natal events (e.g., invariant positioning during sleep) and/or underlying neuropathology. Initial studies of the neurodevelopment of children with DP have found evidence for significant deficits, but methodological problems limit the interpretation of these studies; potential explanations for such findings are unclear. Further investigation is necessary to refine etiological hypotheses and to provide clinicians and parents with accurate information regarding the neurodevelopmental correlates of DP. Several factors indicate the need for rather immediate study of these issues: the rapidly increasing rate of DP (and/or increasing awareness of and parental worry about the condition), the proliferation of associated medical treatments (helmets and craniofacial surgery), the possibility of preventable developmental problems, and the implication of causal association with the American Academy of Pediatrics "Back to Sleep" campaign. In this 5-year longitudinal study, we would like to investigate these issues by recruiting 300 infants with DP and 325 matched controls, following them from age 6 to 36 months. A subgroup of DP cases will be imaged using MRI (n= 46) and compared to controls by sharing data with another NIH-funded study of normal brain development. Specific aims are: (1) Compare the neurodevelopment of infants/toddlers with and without DP using a multi-domain model of neuropsychological development; (2) Among infants with DP, determine the association between neurodevelopmental status and severity of cranial asymmetry (assessed by both clinical judgment and skull imaging); (3) Develop and test a predictive model of 36-month neurodevelopmental outcomes for infants with DP; (4) Evaluate the perceived facial appearance of infants with and without DP (does the condition produce noticeable effects on facial appearance, as many parents fear?); (5) Develop and test a predictive model of parent participation in elective treatments (i.e., what parent/family and infant medical factors best predict treatment participation?) and (6) Using MRI, compare the brain structure and volume of infants with and without DP; among cases, examine relations among brain structure/volume, skull asymmetry, and neuropsychological status.