评估变形性斜头畸形非产科危险因素的证据：系统评价与荟萃分析

Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis.

作者信息

Hillyar Christopher Robert Timothy, Bishop Natalie, Nibber Anjan, Bell-Davies Frances Jean, Ong Juling

机构信息

Oxford Medical School, Green Templeton College, University of Oxford, Oxford, United Kingdom.

UCL Medical School, University College London, London, United Kingdom.

出版信息

Interact J Med Res. 2024 Sep 18;13:e55695. doi: 10.2196/55695.

DOI:10.2196/55695

PMID:39292504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11447428/

Abstract

BACKGROUND

Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry.

OBJECTIVE

The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP.

METHODS

The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots.

RESULTS

A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected.

CONCLUSIONS

This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed.

TRIAL REGISTRATION

PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979.

摘要

背景

扁头畸形被定义为颅骨的不对称变形，导致头部形状呈斜梯形或平行四边形。变形性扁头畸形（DP）是由作用于头后部一侧的力量引起的，破坏了正常的颅骨对称性。

目的

本系统评价和荟萃分析的目的是严格评估DP非产科危险因素的证据，并为降低DP的患病率提出基于证据的建议。

方法

选择标准为报告DP危险因素的研究。排除病例回顾、病例系列、专家意见和系统评价。检索了2010年8月21日至2022年8月21日期间的PubMed和科学网。使用漏斗图评估发表偏倚。使用森林图进行荟萃分析。

结果

共纳入19项研究（队列研究：n = 13，68%；病例对照研究：n = 5，26%；横断面研究：n = 1，5%），共有14808名参与者。在43个被调查的潜在非产科因素中，16个（37%）与DP相关。在这16个因素中，12个（75%）的比值比（OR）及其95%可信区间未超过1：维生素D摄入不足（OR 7.15，95%CI 3.77 - 13.54）、头部位置偏好（OR 4.75，95%CI 3.36 - 6.73）、仅奶瓶喂养（OR 4.65，95%CI 2.70 - 8.00）、俯卧时间减少（OR 3.51，95%CI 1.71 - 7.21）、睡眠姿势（OR 3.12，95%CI 2.21 - 4.39）、6个月龄时达到的运动发育里程碑较少（OR 2.56，95%CI 1.66 - 3.96）、肥胖（OR 2.45，95%CI 1.02 - 5.90）、母亲教育水平（OR 1.66，95%CI 1.17 - 2.37）、男性（OR 1.51，95%CI 1.07 - 2.12）、配方奶喂养（OR 1.51，95%CI 1.00 - 2.27）、头围（OR 1.22，95%CI 1.06 - 1.40）和机械通气（OR 1.10，95%CI 1.00 - 1.14）。未检测到发表偏倚的证据。