From the Division of Plastic Surgery, New York Presbyterian Hospital-Columbia University Medical Center; the Divisions of Plastic and Maxillofacial Plastic Surgery and Neurosurgery, Children's Hospital Los Angeles; the Departments of Pediatrics, Neurological Surgery, and Pathology and Laboratory Medicine, and the Division of Plastic and Reconstructive Surgery, Keck School of Medicine at the University of Southern California.
Plast Reconstr Surg. 2019 Jan;143(1):133e-139e. doi: 10.1097/PRS.0000000000005108.
Some patients with isolated sagittal craniosynostosis have demonstrated mild neurodevelopmental delays. This study examined potential preoperative risk factors for developmental delay.
Patients completed preoperative Bayley Scales of Infant and Toddler Development, Third Edition, and medical records were reviewed. Multivariate analyses of covariance and correlations were calculated.
Participants (n = 77) were predominantly male (77.9 percent) and were aged 2 to 12 months (mean, 5.1 ± 2.3 months). Patients were classified with no delays [n = 63 (82 percent)] or delays [n = 14 (18 percent)] in one or more developmental area(s). There were no group sociodemographic differences. Prenatally, patients with delays versus no delays had lower mean gestational age in weeks (36.9 ± 2.8 weeks versus 39.1 ± 1.7 weeks; p = 0.001) with higher rates of gestational diabetes (36 percent versus 5 percent; p = 0.006) and premature rupture of membranes (14 percent versus 2 percent; p = 0.026). At birth, patients with delays had lower mean birth weight (2982 ± 714 g versus 3374 ± 544 g; p = 0.053), higher rates of respiratory distress (29 percent versus 5 percent; p = 0.005), additional medical diagnoses (57 percent versus 13 percent; p = 0.001), and longer mean neonatal intensive care unit stays (1.4 ± 1.8 weeks versus 0.2 ± 0.9 week; p = 0.002). Variables differing by group had moderate correlations.
Patients with nonsyndromic sagittal craniosynostosis that had delays in development had lower gestational age and birth weight, with more prenatal and birth complications. These factors can help identify patients who might be at risk for delay and need close monitoring.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
一些孤立性矢状缝早闭患者表现出轻度神经发育迟缓。本研究探讨了发育迟缓的潜在术前危险因素。
患者完成了婴儿和学步儿发展的贝利量表，第三版，并且回顾了病历。进行了多元协方差分析和相关性分析。
参与者（n = 77）主要为男性（77.9％），年龄为 2 至 12 个月（平均 5.1 ± 2.3 个月）。患者分为无延迟[n = 63（82％）]或在一个或多个发育领域有延迟[n = 14（18％）]。两组在社会人口统计学方面没有差异。在产前，有延迟的患者与无延迟的患者的平均妊娠周数较低（36.9 ± 2.8 周比 39.1 ± 1.7 周；p = 0.001），并且有更高的妊娠糖尿病发生率（36％比 5％；p = 0.006）和胎膜早破发生率（14％比 2％；p = 0.026）。在出生时，有延迟的患者的平均出生体重较低（2982 ± 714 g 比 3374 ± 544 g；p = 0.053），呼吸窘迫发生率较高（29％比 5％；p = 0.005），其他医疗诊断率较高（57％比 13％；p = 0.001），新生儿重症监护病房住院时间较长（1.4 ± 1.8 周比 0.2 ± 0.9 周；p = 0.002）。按组不同的变量有中度相关性。
患有非综合征性矢状缝早闭且发育迟缓的患者的胎龄和出生体重较低，并且有更多的产前和出生并发症。这些因素可以帮助识别可能有发育迟缓风险并需要密切监测的患者。
临床问题/证据水平：风险，III 级。
