Kapp-Simon K A
The Craniofacial Center, The University of Illinois at Chicago, 60612, USA.
Cleft Palate Craniofac J. 1998 May;35(3):197-203. doi: 10.1597/1545-1569_1998_035_0197_mdaldi_2.3.co_2.
This study examined the global intellectual development and presence/absence of learning disorders in children with nonsyndromic metopic, sagittal, and unilateral coronal synostosis who had early surgery (under 1 year of age), late surgery (over 1 year of age), or no surgery to correct the synostosis across three time periods.
The design was longitudinal. Children were assessed at initial team evaluation, 1 year after surgery or initial evaluation if surgery was not performed, and annually thereafter.
Participants included 84 consecutively evaluated patients. Seventy-two children were evaluated at Time 1 (T1), 8 months; 57 at Time 2 (T2), 21 months; and 39 at Time 3 (T3), 50 months. Data on learning disorders or mental retardation were available on 34 children who were school age.
The Mental Development Index from the Bayley Scales of Infant Development was the main outcome measure for T1 and T2. The General Cognitive Index from the McCarthy Scales of Children's Abilities was the main outcome measure for T3. Learning disorders were determined from school and clinical records.
Repeated measures analyses of variance found no statistical differences in the development of children based on diagnosis or surgical status across time. Base rate of mental retardation at T1 was consistent with normative data; however, the incidence of retardation was two to three times the expected rate at T2 and T3. Learning disorders were present in 47% of school-age children who were not retarded. Chi-square analysis showed no significant differences between rates of retardation or learning disorders based on surgical status.
Most children with nonsyndromic craniosynostosis obtain developmental quotients within the normal range in infancy. Rates of retardation may increase relative to normative expectations as children mature. A high rate of learning disorders was identified. Results are preliminary due to sample size.
本研究调查了患有非综合征性额缝、矢状缝和单侧冠状缝早闭的儿童在三个时间段内的整体智力发育情况以及学习障碍的有无，这些儿童接受了早期手术（1岁以下）、晚期手术（1岁以上）或未进行手术以矫正颅骨缝早闭。
采用纵向研究设计。在初始团队评估时对儿童进行评估，术后1年或若未进行手术则在初始评估后每年进行评估。
参与者包括84名连续接受评估的患者。72名儿童在时间1（T1），即8个月时接受评估；57名在时间2（T2），即21个月时接受评估；39名在时间3（T3），即50个月时接受评估。有34名学龄儿童的学习障碍或智力发育迟缓数据。
贝利婴儿发育量表中的心理发展指数是T1和T2的主要观察指标。麦卡锡儿童能力量表中的一般认知指数是T3的主要观察指标。根据学校和临床记录确定学习障碍。
重复测量方差分析发现，基于诊断或手术状态，儿童在不同时间的发育无统计学差异。T1时智力发育迟缓的基础发生率与标准数据一致；然而，T2和T3时智力发育迟缓的发生率是预期发生率的两到三倍。47%未患智力发育迟缓的学龄儿童存在学习障碍。卡方分析显示，基于手术状态的智力发育迟缓或学习障碍发生率无显著差异。
大多数患有非综合征性颅骨缝早闭的儿童在婴儿期获得的发育商在正常范围内。随着儿童成熟，智力发育迟缓的发生率可能相对于标准预期增加。发现学习障碍的发生率较高。由于样本量的原因，结果为初步结果。
