van Vlimmeren Leo A, van der Graaf Yolanda, Boere-Boonekamp Magda M, L'Hoir Monique P, Helders Paul J M, Engelbert Raoul H H
Department of Physical Therapy, Bernhoven Hospital, Veghel, The Netherlands.
Pediatrics. 2007 Feb;119(2):e408-18. doi: 10.1542/peds.2006-2012.
The purpose of this work was to identify risk factors for deformational plagiocephaly within 48 hours of birth and at 7 weeks of age.
This was a prospective cohort study in which 380 healthy neonates born at term in Bernhoven Hospital in Veghel were followed at birth and at 7 weeks of age. Data regarding obstetrics, sociodemographics, asymmetry of the skull, anthropometrics, motor development, positioning, and care factors related to potentially provoking deformational plagiocephaly were gathered, with special interest for putative risk factors. The main outcome measure at birth and at 7 weeks of age was deformational plagiocephaly, assessed using the plagiocephalometry parameter oblique diameter difference index, a ratio variable, calculated as the longest divided by the shortest oblique diameter of the skull x 100%. A cutoff point of > or = 104% was used to indicate severe deformational plagiocephaly.
Only in 9 of 23 children who presented deformational plagiocephaly at birth was deformational plagiocephaly present at follow-up, whereas in 75 other children, deformational plagiocephaly developed between birth and follow-up. At birth, 3 of 14 putative risk factors were associated with severe flattening of the skull: gender, birth rank, and brachycephaly. At 7 weeks of age, 8 of 28 putative risk factors were associated with severe flattening: gender, birth rank, head position when sleeping, position on chest of drawers, method of feeding, positioning during bottle-feeding, and tummy time when awake. Early achievement of motor milestones was a protective factor for developing deformational plagiocephaly. Deformational plagiocephaly at birth was not a predictor for deformational plagiocephaly at 7 weeks of age. There was no significant relation between supine sleeping and deformational plagiocephaly.
Three determinants were associated with an increased risk of deformational plagiocephaly at birth: male gender, first-born birth rank, and brachycephaly. Eight factors were associated with an increased risk of deformational plagiocephaly at 7 weeks of age: male gender, first-born birth rank, positional preference when sleeping, head to the same side on chest of drawers, only bottle feeding, positioning to the same side during bottle feeding, tummy time when awake < 3 times per day, and slow achievement of motor milestones. This study supports the hypothesis that specific nursing habits, as well as motor development and positional preference, are primarily associated with the development of deformational plagiocephaly. Earlier achievement of motor milestones probably protects the child from developing deformational plagiocephaly. Implementation of practices based on this new evidence of preventing and diminishing deformational plagiocephaly in child health care centers is very important.
本研究旨在确定出生48小时内及7周龄时发生变形性斜头畸形的风险因素。
这是一项前瞻性队列研究，对380名在费赫尔的伯恩霍芬医院足月出生的健康新生儿在出生时及7周龄时进行随访。收集了有关产科情况、社会人口统计学、颅骨不对称性、人体测量学、运动发育、姿势以及与可能引发变形性斜头畸形相关的护理因素的数据，特别关注假定的风险因素。出生时及7周龄时的主要结局指标为变形性斜头畸形，使用斜头测量参数斜径差异指数进行评估，该指数为比率变量，计算方法为颅骨最长斜径除以最短斜径×100%。截断点≥104%用于指示严重变形性斜头畸形。
出生时出现变形性斜头畸形的23名儿童中，只有9名在随访时仍存在变形性斜头畸形，而在其他75名儿童中，变形性斜头畸形在出生至随访期间出现。出生时，14个假定风险因素中有3个与颅骨严重扁平有关：性别、出生顺序和短头畸形。在7周龄时，28个假定风险因素中有8个与严重扁平有关：性别、出生顺序、睡眠时头部位置、在抽屉柜上的姿势、喂养方式、奶瓶喂养时的姿势以及清醒时趴卧时间。运动里程碑的早期达成是预防变形性斜头畸形的保护因素。出生时的变形性斜头畸形并非7周龄时变形性斜头畸形的预测指标。仰卧睡眠与变形性斜头畸形之间无显著关联。
三个因素与出生时变形性斜头畸形风险增加相关：男性、头胎出生顺序和短头畸形。八个因素与7周龄时变形性斜头畸形风险增加相关：男性、头胎出生顺序、睡眠时的姿势偏好、在抽屉柜上头部偏向同一侧、仅采用奶瓶喂养、奶瓶喂养时偏向同一侧的姿势、清醒时趴卧时间<每天3次以及运动里程碑达成缓慢。本研究支持以下假设，即特定的护理习惯以及运动发育和姿势偏好主要与变形性斜头畸形的发生相关。运动里程碑的较早达成可能使儿童免受变形性斜头畸形的影响。在儿童保健中心基于这一新证据实施预防和减少变形性斜头畸形的措施非常重要。
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