Neurodevelopment Among Infants with Deformational Plagiocephaly

描述（由申请人提供）：变形斜头畸形（DP）是指由于婴儿颅骨可塑性受到外力塑造而导致的颅骨不对称。可疑的偶然因素包括产前因素（如宫内约束）、产后事件（如睡眠时固定体位）和/或潜在的神经病理。对DP患儿神经发育的初步研究发现了显著缺陷的证据，但方法学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。进一步的调查是必要的，以完善病因假说，并为临床医生和家长提供关于DP神经发育相关的准确信息。有几个因素表明需要立即研究这些问题：迅速增加的DP发病率（和/或对这种情况的认识和父母对这种情况的担忧日益增加），相关医疗方法（头盔和颅面手术）的普及，可预防的发育问题的可能性，以及与美国儿科学会“恢复睡眠”运动的因果关系。在这项为期5年的纵向研究中，我们希望通过招募300名患有DP的婴儿和325名匹配的对照组来调查这些问题，从6个月到36个月。DP病例亚组将使用MRI成像（n= 46），并通过与另一项由nih资助的正常大脑发育研究共享数据与对照组进行比较。具体目的是：(1)利用神经心理发展多域模型比较有DP和无DP婴幼儿的神经发育；(2)在DP患儿中，确定神经发育状况与颅不对称严重程度之间的关系（通过临床判断和颅骨影像学评估）；(3)建立并测试DP患儿36个月神经发育结局预测模型；(4)评估患有和不患有DP的婴儿的面部外观（是否如许多父母所担心的那样，该病症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，父母/家庭和婴儿的哪些医学因素最能预测治疗参与？）(6)使用MRI，比较有和没有DP的婴儿的大脑结构和体积；在病例中，检查脑结构/体积、颅骨不对称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.