Hui Lai Ling, Ho Frederick K, Wright Charlotte Margaret, Cole Tim J, Lam Hugh Simon, Deng Han-Bing, So Hung-Kwan, Ip Patrick, Nelson E Anthony S
Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China.
Arch Dis Child. 2023 May;108(5):373-378. doi: 10.1136/archdischild-2022-324661. Epub 2023 Mar 16.
A recent review reported that the WHO 2006 growth standards reflect a smaller head circumference at 24 months than seen in 18 countries. Whether this happens in early infancy and to what extent populations differ is not clear. This scooping review aimed to estimate the rates of children in different populations identified as macrocephalic or microcephalic by WHO standards.
We reviewed population-representative head circumference-for-age references. For each reference, we calculated the percentages of head circumferences that would be classified as microcephalic (<3rd WHO centile) or macrocephalic (>97th WHO centile) at selected ages.
Twelve references from 11 countries/regions (Belgium, China, Ethiopia, Germany, Hong Kong, India, Japan, Norway, Saudi Arabia, UK and USA) were included. Median head circumference was larger than that for the Multicentre Growth Reference Study populations in both sexes in all these populations except for Japanese and Chinese children aged 1 month and Indians. Overall, at 12/24 months, 8%-9% children would be classified as macrocephalic and 2% would be classified as microcephalic, compared with the expected 3%. However at 1 month, there were geographic differences in the rate of macrocephaly (6%-10% in Europe vs 1%-2% in Japan and China) and microcephaly (1%-3% vs 6%-14%, respectively).
Except for Indians and some Asian neonates, adopting the WHO head circumference standards would overdiagnose macrocephaly and underdiagnose microcephaly. Local population-specific cut-offs or references are more appropriate for many populations. There is a need to educate healthcare professionals about the limitations of the WHO head circumference standards.
最近一项综述报告称，世界卫生组织（WHO）2006年生长标准显示，24个月大婴儿的头围比18个国家的情况要小。在婴儿早期是否也是如此以及不同人群之间的差异程度尚不清楚。这项全面综述旨在估计按照WHO标准被认定为巨头畸形或小头畸形的不同人群中儿童的比例。
我们查阅了具有人群代表性的年龄别头围参考资料。对于每份参考资料，我们计算了在选定年龄时被归类为小头畸形（<WHO第3百分位数）或巨头畸形（>WHO第97百分位数）的头围百分比。
纳入了来自11个国家/地区（比利时、中国、埃塞俄比亚、德国、中国香港、印度、日本、挪威、沙特阿拉伯、英国和美国）的12份参考资料。除了1个月大的日本和中国儿童以及印度儿童外，所有这些人群中男女的头围中位数均大于多中心生长参考研究人群的头围中位数。总体而言，在12/24个月时，8%-9%的儿童会被归类为巨头畸形，2%会被归类为小头畸形，而预期比例为3%。然而在1个月时，巨头畸形率存在地理差异（欧洲为6%-10%，日本和中国为1%-2%），小头畸形率也存在地理差异（分别为1%-3%和6%-14%）。
除了印度人和一些亚洲新生儿外，采用WHO头围标准会过度诊断巨头畸形，而对小头畸形诊断不足。许多人群采用当地特定人群的临界值或参考资料更为合适。有必要让医疗保健专业人员了解WHO头围标准的局限性。
