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Buil A, Thomas N, Chevalier B, Devouche E. Effects of skin-to-skin contact in supported diagonal flexion positioning on movement quality in very preterm infants at term age. Early Hum Dev 2024; 190:105954. [PMID: 38340687 DOI: 10.1016/j.earlhumdev.2024.105954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Preterm birth is associated with a high risk of long-term neuromotor disabilities such as coordination of movements, deficient antigravity limb movement, less adaptive postural control strategies, head deformities… AIMS: The aim of the present study was to examine the potential positive impact of a Supported Diagonal Flexion (SDF) skin-to-skin contact (SSC) positioning on the neuromotor development and movement quality of very preterm infants at term age. STUDY DESIGN Monocentric prospective matched-pair case-control study. SUBJECTS Thirty very preterm infants and their mother were proposed either SDF SSC positioning (n = 15) or Vertical SSC positioning (n = 15). OUTCOME MEASURES Amiel-Tison Neurological Assessment at Term (ATNAT) and observation of the spontaneous motor activity were assessed at term corrected age. RESULTS Infants in the SDF group had less dolichocephaly (adj. p = .014) and arms in candlestick position (adj. p = .048). Only 3 in the SDF group against 11 in the vertical group showed nonoptimal spontaneous motor activity. Infants in the SDF group had more positive signs such as foot-to-foot contact (adj. p = .047) or arms movements toward midline (adj. p = .046 and 0.011). CONCLUSIONS The present study shows that nonoptimal spontaneous motor activity was increased and dolichocephaly was more common in the vertical group. Consistently with current guidelines, it is critical to consider preterm infants' postures during SSC or while in incubators or cradles.
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Affiliation(s)
- Aude Buil
- Centre de Recherche Clinique_Service de réanimation et médecine néonatale, CHI Créteil, France; Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé (LPPS ER4057), France.
| | - Nelly Thomas
- Service de Réanimation et Médecine Néonatale, CHI Créteil, France.
| | - Benoît Chevalier
- Laboratoire Cognition Humaine et Artificielle, Ecole Pratique des Hautes Etudes, Paris_Luciole Formation, Angers, France
| | - Emmanuel Devouche
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé (LPPS ER4057), France
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McCarty DB, Hite A, Brown A, Blazek K, Quinn L, Hammond S, Boynton M, O’Shea TM. A pilot exploratory study examining the potential influence of continuous positive airway pressure devices on cranial molding trajectories in preterm infants. PLoS One 2023; 18:e0292671. [PMID: 37824471 PMCID: PMC10569633 DOI: 10.1371/journal.pone.0292671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The objective of this exploratory study was to assess the potential impacts of two different continuous positive airway pressure (CPAP) devices on preterm infant head shape and circumference. STUDY DESIGN Twenty infants born at <32 weeks gestational age requiring CPAP support were enrolled. Ten infants used the Hudson RCI Nasal Prong CPAP device and 10 infants used the Fisher-Paykel CPAP device. Infant Cranial Index (CI) and head circumference (HC) were collected weekly as well as infant gestational age at birth, and total number of days on CPAP. RESULTS At baseline, average total birthweight of infants was 1021 grams (SD = 227 grams), average gestational age was 26.9 weeks (SD = 1.80), mean CI was 79.7 cm (SD = 5.95), and HC was 10.2 cm (SD = 0.92). Days on CPAP ranged from 16 to 63 days, with an average of 40.7 (SD = 13.6) days. Neither CI nor HC differed by device type; however, the Fisher-Paykel device was associated with slightly greater HC growth rate. CONCLUSION CPAP devices and the pressures they apply plausibly contribute to preterm infant cranial molding over time, with the greatest potential impact on infants who require CPAP support for longer periods; however, these findings must be validated in larger cohorts. Additionally, positioning practices should be further examined to determine how they may contribute to or prevent the development of cranial molding deformity.
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Affiliation(s)
- Dana B. McCarty
- Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Ashley Hite
- Department of Rehabilitation Services, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States of America
| | - Anna Brown
- Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Kerry Blazek
- Department of Rehabilitation Services, UNC Children’s Hospital, Chapel Hill, North Carolina, United States of America
| | - Lauren Quinn
- Department of Rehabilitation Services, UNC Children’s Hospital, Chapel Hill, North Carolina, United States of America
| | - Sara Hammond
- Department of Rehabilitation Services, UNC Children’s Hospital, Chapel Hill, North Carolina, United States of America
| | - Marcella Boynton
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Yang L, Fu H, Zhang L. A systematic review of improved positions and supporting devices for premature infants in the NICU. Heliyon 2023; 9:e14388. [PMID: 36967878 PMCID: PMC10031313 DOI: 10.1016/j.heliyon.2023.e14388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background In the neonatal intensive care unit, nurses often place premature infants in the supine, prone, and lateral positions. However, these positions do not always meet all the physiological needs of premature infants. Thus, many improved positions and various position-supporting devices have been studied to provide infants with a development-friendly and comfortable environment. Aim We aimed to help nurses recognize and understand the various improved positions and devices, and to provide nurses with more options in addressing the needs of preterm infants. Study design We searched PubMed, Web of Science, and EMBASE from 2012 to 2022 for studies on position management of preterm infants, and screened the search results according to inclusion and exclusion criteria. Then we extracted data and evaluated the quality of the included studies. Finally, we conducted a qualitative summary of the results. Results Twenty-one articles were included in this review. Fourteen were studies about improved positions, including hammock position, facilitated tucking position, ROP position, reverse kangaroo mother care position (R-KMC), and supported diagonal flexion position (SDF). Seven were studies on positioning devices, four on cranial deformity prevention, and three on reformative swaddling. They have a positive impact on sleep and flexion maintenance, in addition, they can prevent head deformity and reduce the pain of premature infants. Conclusion The position management of premature infants is diversified. Instead of sticking to a single position placement, nurses should adjust the position according to the unique physiological conditions of infants to reduce sequelae and promote their recovery and growth during long-term hospitalization. There should be more studies on position management with large sample sizes in the future.
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Satanin LA, Dzhandzhgava NN, Evteev AA, Chernikova NA, Sakharov AV, Ivanov AL, Tere VA, Roginsky VV. [Difficulties in differential diagnosis of sagittal synostosis (scaphocephaly)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:74-82. [PMID: 37650279 DOI: 10.17116/neiro20238704174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Craniosynostosis is characterized by congenital absence or premature closure of skull sutures. The most common form of craniosynostosis is synostosis of sagittal suture followed by scaphocephaly. There are some head deformities similar to scaphocephaly such as positional and constitutional dolichocephaly, etc. These patients have no sagittal suture synostosis. However, there are difficulties in differential diagnosis between these deformities and scaphocephaly. OBJECTIVE To develop differential diagnostic criteria between dolichocephalic head deformities and true scaphocephaly following sagittal synostosis. MATERIAL AND METHODS The study included 33 patients with dolichocephaly (25 (75.8%) boys and 8 (24.2%) girls) between December 2013 and August 2022. The inclusion criterion was available CT or ultrasound data confirming or excluding sagittal synostosis. Age of patients was 8.62±7.71 (1.77-36) months. We analyzed anamnestic, clinical and radiological data. Radiological data was compared with diagnostic findings in 20 patients with scaphocephaly. Both groups were comparable in age, gender and cranial index. RESULTS We present clinical and radiological signs, as well as algorithm for differential diagnosis between scaphocephaly and dolichocephaly. CONCLUSION There are objective difficulties in differential diagnosis between scaphocephaly following sagittal synostosis and dolichocephalic head deformities. In most cases, we cannot establish the cause of congenital forms of dolichocephaly. The most likely causes may be pre- and postnatal compressive and positional effects. Ultrasound of skull sutures is preferable for differential diagnosis between these abnormalities. Correction of dolichocephaly can be carried out according to aesthetic indications with individual cranial orthoses.
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Affiliation(s)
- L A Satanin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - N N Dzhandzhgava
- Kulakov Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - A A Evteev
- Lomonosov Moscow State University, Research Institute and Museum of Anthropology, Moscow, Russia
| | | | | | - A L Ivanov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V A Tere
- Burdenko Neurosurgical Center, Moscow, Russia
| | - V V Roginsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Lo AL, Hallac RR, Chen SH, Hsu KH, Wang SW, Chen CH, Lien RY, Lo LJ, Chou PY. Craniofacial Growth and Asymmetry in Newborns: A Longitudinal 3D Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12133. [PMID: 36231433 PMCID: PMC9564900 DOI: 10.3390/ijerph191912133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life. METHODS The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated. RESULTS A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age. CONCLUSIONS A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.
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Affiliation(s)
- Ai-Lun Lo
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Rami R. Hallac
- Analytical Imaging and Modeling Center, Children’s Health Dallas, UTSW Medical Center, Dallas, TX 75390, USA
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou 33302, Taiwan
| | - Sheng-Wei Wang
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 11221, Taiwan
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Rei-Yin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou 33302, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052045. [PMID: 34155134 DOI: 10.1542/peds.2021-052045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (ie, weight <2500 g) and 10% were born preterm (ie, gestational age of <37 weeks). Ten to fifteen percent of infants (approximately 500 000 annually), including low birth weight and preterm infants and others with congenital anomalies, perinatally acquired infections, and other diseases, require admission to a NICU. Every year, approximately 3600 infants in the United States die of sudden unexpected infant death (SUID), including sudden infant death syndrome (SIDS), unknown and undetermined causes, and accidental suffocation and strangulation in an unsafe sleep environment. Preterm and low birth weight infants are 2 to 3 times more likely than healthy term infants to die suddenly and unexpectedly. Thus, it is important that health care professionals prepare families to maintain their infant in a safe home sleep environment as per recommendations of the American Academy of Pediatrics. Medical needs of the NICU infant often require practices such as nonsupine positioning, which should be transitioned as soon as medically possible and well before hospital discharge to sleep practices that are safe and appropriate for the home environment. This clinical report outlines the establishment of appropriate NICU protocols for the timely transition of these infants to a safe home sleep environment. The rationale for these recommendations is discussed in the accompanying technical report "Transition to a Safe Home Sleep Environment for the NICU Patient," included in this issue of Pediatrics.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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7
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Goodstein MH, Stewart DL, Keels EL, Moon RY. Transition to a Safe Home Sleep Environment for the NICU Patient. Pediatrics 2021; 148:peds.2021-052046. [PMID: 34155135 DOI: 10.1542/peds.2021-052046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Of the nearly 3.8 million infants born in the United States in 2018, 8.3% had low birth weight (<2500 g [5.5 lb]) and 10% were born preterm (gestational age of <37 completed weeks). Many of these infants and others with congenital anomalies, perinatally acquired infections, and other disease require admission to a NICU. In the past decade, admission rates to NICUs have been increasing; it is estimated that between 10% and 15% of infants will spend time in a NICU, representing approximately 500 000 neonates annually. Approximately 3600 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome International Classification of Diseases, 10th Revision (R95), ill-defined deaths (R99), and accidental suffocation and strangulation in bed (W75). Preterm and low birth weight infants are particularly vulnerable, with an incidence of death 2 to 3 times greater than healthy term infants. Thus, it is important for health care professionals to prepare families to maintain their infant in a safe sleep environment, as per the recommendations of the American Academy of Pediatrics. However, infants in the NICU setting commonly require care that is inconsistent with infant sleep safety recommendations. The conflicting needs of the NICU infant with the necessity to provide a safe sleep environment before hospital discharge can create confusion for providers and distress for families. This technical report is intended to assist in the establishment of appropriate NICU protocols to achieve a consistent approach to transitioning NICU infants to a safe sleep environment as soon as medically possible, well before hospital discharge.
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Affiliation(s)
- Michael H Goodstein
- Division of Newborn Services, WellSpan Health, York, Pennsylvania .,Department of Pediatrics, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's and School of Medicine, University of Louisville, Louisville, Kentucky
| | - Erin L Keels
- National Association of Neonatal Nurse Practitioners, National Association of Neonatal Nurses, Chicago, Illinois.,Neonatal Advanced Practice, Nationwide Children's Hospital, Columbus, Ohio
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Rethinking Farkas: Updating Cephalic Index Norms in a Large, Diverse Population. Plast Reconstr Surg 2021; 147:1369-1376. [PMID: 33973960 DOI: 10.1097/prs.0000000000007957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cephalic index, the ratio of head width to length, is one normative indicator used by insurers to derive criteria for plagiocephaly helmet authorization. Current norms were established by a small sample of white children in the 1987 Farkas and Munro data set. This study establishes updated cephalic index values for infants and children in a large, diverse patient population. METHODS Children aged 0 to 3 months, 3 to 6 months, 9 to 12 months, 2 to 3 years, and 12 to 14 years were recruited at their well-child appointment. Cephalic index was calculated for each age group and compared to previously established norms. RESULTS Eight hundred seventy patients met inclusion criteria. The means for boys and girls between 0 and 6 months were 83.5 (n = 155, SD 6.01) and 83.5 (n = 191, SD 5.80), respectively. Established means for boys and girls between 0 and 6 months were 74.4 (n = 38, SD 5.2) and 74.3 (n = 49, SD 6.1), respectively. The difference between norms is highly statistically significant (p < 0.0001). For this age range, insurance criteria for a helmet is >83.7 for boys and >82.7 for girls. Using previous norms, 74 boys (44.6 percent) and 104 girls (54.5 percent) would meet criteria for a helmet under current guidelines. CONCLUSIONS The mean cephalic index of children has changed. The reasons could include diversifying populations in the United States and the introduction of the Back to Sleep campaign. Over 50 percent of children may inappropriately meet criteria for a helmet based on prior norms. Updating norms could change the definition of plagiocephaly for a helmet orthosis.
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9
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Nonsynostotic Plagiocephaly: Prevention Strategies in Child Health Care. J Clin Med 2020; 9:jcm9123946. [PMID: 33291382 PMCID: PMC7762044 DOI: 10.3390/jcm9123946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly.
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Delteil C, Lesieur E, Tuchtan L, Carballeira Alvarez A, Chaumoitre K, Saliba B, Adalian P, Piercecchi-Marti MD. Study of the growth and shape of the brain and cranial base during the first two years of life. Morphologie 2020; 105:45-53. [PMID: 33069567 DOI: 10.1016/j.morpho.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Ontogeny of the cranial base and the brain integrates data on growth, maturation and ontogenetic allometry of these two systems in the course of development. The aim of our work was to study the ontogeny of the cranial base and the brain in order to understand their growth dynamic and shape changes using a traditional morphometric approach in individuals with normal (non-pathological) development. MATERIEL AND METHOD Forty-seven infants having been included in the unexpected infant death french protocol were analyzed. Medical imaging (CT and MRI) exams, followed by an autopsy and pathology examination allowed us to include only infants free from brain disease or pathology affecting growth. RESULTS Testing of measurement reliability validated 12 distances and 3 angles as well as the positioning of the landmarks that had been used to obtain the distances and the angles. No correlation between sex and the various variables studied was found. However, a correlation was observed between these variables and age, making it possible to propose a growth curve. A medium to strong correlation was found between brain variables and the bone variables of the cranial base, underlining the parallel development of the two systems. CONCLUSION Our study, carried out in a rigorously selected population of infants, presents a fundamental approach to the study of ontogenesis.
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Affiliation(s)
- C Delteil
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - E Lesieur
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | - L Tuchtan
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France
| | - A Carballeira Alvarez
- Department of Radiology, Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147, boulevard Baille, 13005 Marseille Cedex 05, France
| | - K Chaumoitre
- Department of Radiology, CHU Nord, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - B Saliba
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - P Adalian
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - M-D Piercecchi-Marti
- Forensic Department, APHM, La Timone, 264, rue St Pierre, 13385 Marseille Cedex 05, France
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Uchio Y, Shima N, Nakamura K, Ikai T, Nitta O. Effects of continued positioning pillow use until a corrected age of six months on cranial deformation and neurodevelopment in preterm infants: A prospective case-control study. Early Hum Dev 2020; 148:105137. [PMID: 32682000 DOI: 10.1016/j.earlhumdev.2020.105137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preterm infants have a high risk of cranial deformity resulting from external pressures. Such deformity is associated with delayed neurodevelopment. AIMS We aimed to clarify the effects of continuous use of positioning pillows on cranial deformity and neurodevelopment in preterm infants. METHODS This prospective case-control study was conducted between November 2018 and August 2019. The continuous use of a pillow was initiated after discharge from the neonatal intensive care unit, up to a corrected age of six months. Preterm infants weighing less than 1800 g without neurological abnormalities were included in the study. Patients were divided into two groups: non-pillow group (NP-group) and pillow group (P-group). The primary outcome was the Bayley Scales of Infant Development III (BSID-III) score. We compared asymmetrical cranial deformity and the BSID-III scores in the two groups at a corrected age of six months using the Fisher's exact test and unpaired t-test, respectively. RESULTS There were 19 preterm infants (mean gestational age 32.5 ± 1.9 weeks, birth weight 1461.3 ± 244.7) eligible during the study period. The P-group (n = 11) showed asymmetrical cranial deformity at six months less frequently than the NP-group (n = 8) (p = 0.001, Fisher's exact test). Infants in the P-group had significantly higher scores on the BSID-III cognitive scales (95.0 ± 8.4 vs. 86.9 ± 2.6; p = 0.02, unpaired t-test) and fine motor scores on the motor scales (8.6 ± 2.2 vs. 6.6 ± 0.7, p = 0.02, unpaired t-test). CONCLUSIONS Continuous pillow use in preterm infants is effective in reducing cranial deformity and improved cognitive and fine motor skills. TRIAL REGISTRATION UMIN Clinical Trials Registry, trial no. UMIN000034400 (http://www.umin.ac.jp/ctr/index.htm).
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Affiliation(s)
- Yuu Uchio
- Department of Rehabilitation, Tokyo Women's Medical University, Tokyo, Japan; Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; Department of Rehabilitation, Faculty of Health Sciences, University of Tokyo Health Sciences, Tokyo, Japan.
| | - Naoko Shima
- Department of Rehabilitation, Tokyo Women's Medical University, Tokyo, Japan
| | - Kaho Nakamura
- Department of Rehabilitation, Tokyo Women's Medical University, Tokyo, Japan
| | - Tetsuo Ikai
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Osamu Nitta
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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12
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Ahluwalia R, Foster J, Sherburn MM, Sellyn GE, Kelly KA, Abdul Ghani MO, Wiseman AL, Shannon CN, Bonfield CM. Deformational brachycephaly: the clinical utility of the cranial index. J Neurosurg Pediatr 2020; 26:122-126. [PMID: 32357338 DOI: 10.3171/2020.2.peds19767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence of deformational brachycephaly has risen since the "Back to Sleep" movement in 1992 by the American Academy of Pediatrics. Brachycephaly prevalence and understanding the dynamic nature of the pediatric skull have not been explored in relation to the cranial index (CI). The objective of the study was to determine the prevalence of brachycephaly, via the CI, with respect to time. METHODS The authors conducted a retrospective review of 1499 patients ≤ 19 years of age who presented for trauma evaluation with a negative CT scan for trauma (absence of bleed) in 2018. The CI was calculated using CT at the lateral-most point of the parietal bone (cephalic width), and the distance from the glabella to the opisthocranion (cephalic length). Brachycephaly was defined as a CI ≥ 90%. RESULTS The mean CI was 82.6, with an average patient age of 6.8 years. The prevalence of deformational brachycephaly steadily decreased from 27% to 4% from birth to > 2 years of life. The mean CI was statistically different between ages < 12 months, 12-24 months, and > 24 months (F[2,1496] = 124.058, p < 0.0005). A simple linear regression was calculated to predict the CI based on age; the CI was found to decrease by 0.038 each month. A significant regression equation was found (F[1,1497] = 296.846, p < 0.0005), with an R2 of 0.140. CONCLUSIONS The incidence of deformational brachycephaly is common in infants but decreases as the child progresses through early childhood. Clinicians can expect a significant decrease in mean CI at 12 and 24 months. Additionally, these regression models show that clinicians can expect continued improvement throughout childhood.
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Affiliation(s)
- Ranbir Ahluwalia
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 2Florida State University College of Medicine, Tallahassee, Florida
| | - Jarrett Foster
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 3University of South Carolina School of Medicine, Columbia, South Carolina; and
| | - Madeleine M Sherburn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Georgina E Sellyn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Katherine A Kelly
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Muhammad Owais Abdul Ghani
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Alyssa L Wiseman
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Ellwood J, Draper-Rodi J, Carnes D. The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: a synthesis of systematic reviews and guidance. Chiropr Man Therap 2020; 28:31. [PMID: 32522230 PMCID: PMC7288527 DOI: 10.1186/s12998-020-00321-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
AIM To investigate for congenital muscular torticollis (CMT) and positional plagiocephaly (PP) the effectiveness and safety of manual therapy, repositioning and helmet therapy (PP only) using a systematic review of systematic reviews and national guidelines. METHODS We searched four major relevant databases: PubMed, Embase, Cochrane and MANTIS for research studies published between the period 1999-2019. Inclusion criteria were systematic reviews that analysed results from multiple studies and guidelines that used evidence and expert opinion to recommend treatment and care approaches. Three reviewers independently selected articles by title, abstract and full paper review, and extracted data. Selected studies were described by two authors and assessed for quality. Where possible meta-analysed data for change in outcomes (range of movement and head shape) were extracted and qualitative conclusions were assessed. RESULTS We found 10 systematic reviews for PP and 4 for CMT. One national guideline was found for each PP and CMT. For PP, manual therapy was found to be more effective than repositioning including tummy time (moderate to high evidence) but not better than helmet therapy (low evidence). Helmet therapy was better than usual care or repositioning (low evidence); and repositioning better than usual care (moderate to high evidence). The results for CMT showed that manual therapy in the form of practitioner-led stretching had moderate favourable evidence for increased range of movement. Advice, guidance and parental support was recommended in all the guidance to reassure parents of the favourable trajectory and nature of these conditions over time. CONCLUSIONS Distinguishing between superiority of treatments was difficult due to the lack of standardised measurement systems, the variety of outcomes and limited high quality studies. More well powered effectiveness and efficacy studies are needed. However overall, advice and guidance on repositioning (including tummy-time) and practitioner-led stretching were low risk, potentially helpful and inexpensive interventions for parents to consider. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2019 CRD42019139074.
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Affiliation(s)
- Julie Ellwood
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England
| | - Jerry Draper-Rodi
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England
| | - Dawn Carnes
- University College Osteopathy, 275 Borough High St, London, SE1 1JE, England.
- Faculty of Health, University Applied Sciences and the Arts Western Switzerland, Fribourg, Switzerland.
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Jung BK, Yun IS. Diagnosis and treatment of positional plagiocephaly. Arch Craniofac Surg 2020; 21:80-86. [PMID: 32380806 PMCID: PMC7206465 DOI: 10.7181/acfs.2020.00059] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
Positional plagiocephaly is increasing in infants. Positional plagiocephaly is an asymmetric deformation of skull due to various reasons; first birth, assisted labor, multiple pregnancy, prematurity, congenital muscular torticollis and position of head. Positional plagiocephaly can mostly be diagnosed clinically and by physical examinations. The simplest way to assess the severity of plagiocephaly is to use a diagonal caliper during physical examination, which measures the difference between the diagonal lengths on each side of the head. Plagiocephaly can be treated surgically or conservatively. Positional plagiocephaly, which is not accompanied by craniosynostosis, is treated conservatively. Conservative treatments involve a variety of treatments, such as change of positions, physiotherapy, massage therapy, and helmet therapy. Systematic approaches to clinical examination, diagnosis and treatment of positional plagiocephaly can be necessary and the age-appropriate treatment is recommended for patients with positional plagiocephaly.
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Affiliation(s)
- Bok Ki Jung
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
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Kim EH, Kim KE, Jeon J, Sheen YH, Lee HS, Yoon SY, Kim NH, Choi KM. Delayed Motor Development and Infant Obesity as Risk Factors for Severe Deformational Plagiocephaly: A Matched Case-Control Study. Front Pediatr 2020; 8:582360. [PMID: 33262962 PMCID: PMC7686236 DOI: 10.3389/fped.2020.582360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
The prevalence of deformational plagiocephaly (DP) has increased since the recommendation of positioning infants to their back during sleeping and is affected by various biological and environmental factors. This study aimed to investigate associations between DP and perinatal or infant characteristics, including obesity. This case-control study included 135 infants (81 males) aged 2-12 months who were diagnosed with DP using calculated cranial vault asymmetric index and cranial index and 135 age- and sex-matched controls. Motor development was evaluated using the Alberta Infant Motor Scale, and obesity was defined by body mass index. Univariate and multivariate logistic regression models were used to assess potential risk factors for DP and its severity. One hundred thirty-five infants with DP were divided into the following three subgroups according to severity indicated by the cranial vault asymmetry index: mild to moderate group (n = 87, 64.4%), severe group (n = 48, 35.6%), and a combined plagiocephaly and brachycephaly group (n = 79, 58.5%). Independent risk factors significantly associated with development of DP were bottle-only feeding (adjusted odds ratio (aOR) = 4.65; 95% CI: 2.70-8.00), little tummy time when awake (aOR = 3.51, 95% CI: 1.71-7.21), delay of motor development (aOR = 2.85, 95% CI: 1.08-7.49), and obesity at diagnosis (aOR = 2.45, 95% CI: 1.02-5.90). Among these risk factors, delay of motor development (aOR = 4.91, 95% CI: 1.46-16.51) and obesity at diagnosis (aOR = 4.10, 95% CI: 1.42-11.90) were particularly related to severe DP. In conclusion, this study confirms that DP risk is positively associated with bottle-only feeding, infrequent tummy time, and delayed development of motor milestones. Notably, this study demonstrates infant obesity as a new risk factor for DP. Our findings suggest that obesity should be identified early and managed comprehensively in infants with DP.
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Affiliation(s)
- Eun-Hee Kim
- Department of Pediatrics, Sejong Chungnam National University Hospital, Chungnam National University School of Medicine, Sejong, South Korea.,Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Ki Eun Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Jihyun Jeon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Hyun-Seung Lee
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - So Young Yoon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Nam Hyo Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Kyoung Min Choi
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
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Feasibility and Safety of the Preemie Orthotic Device to Manage Deformational Plagiocephaly in Extremely Low Birth Weight Infants. Adv Neonatal Care 2019; 19:226-235. [PMID: 30724785 DOI: 10.1097/anc.0000000000000585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature infants are predisposed to developing deformational plagiocephaly. Deformational plagiocephaly may affect the infant's social well-being and neurobehavioral development. PURPOSE This pilot study investigated the feasibility and safety of the preemie orthotic device (POD); a noncommercial, supportive orthotic device to manage deformational plagiocephaly. METHODS The setting for this prospective, descriptive, phase 1 clinical trial was 2 urban and 1 suburban neonatal intensive care units that provided care for critically ill premature and term infants. Participants included a convenience sample of 10 premature extremely low-birth-weight infants weighing less than 1 kg. All participants received the experimental treatment with the POD. Time spent on the device with and without the supportive foam insert, provider perception, adverse events, and head shape measurements were collected to assess feasibility and safety of the device. RESULTS Participants had a median gestational age of 25.4 weeks and median birth weight of 0.673 kg. The POD was used a median of 21.2 hours per day and the foam insert was used a median of 11.1 hours per day. At enrollment, 1 participant had a normal cranial index compared with 5 participants at study completion. All participants had normal cranial symmetry at study enrollment and completion. No device-related adverse events were reported. IMPLICATION FOR PRACTICE The POD was found to be feasible and safe. Staff had favorable responses to the device. Recommendations by nursing staff included enlarging the device to extend its use. IMPLICATION FOR RESEARCH Further studies are warranted to assess the POD's effectiveness.
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Charafeddine L, Masri S, Ibrahim P, Badin D, Cheayto S, Tamim H. Targeted educational program improves infant positioning practice in the NICU. Int J Qual Health Care 2019; 30:642-648. [PMID: 29889251 DOI: 10.1093/intqhc/mzy123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
Quality problem or issue Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning. Initial assessment Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4. Choice of solution Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice. Implementation Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results. Evaluation Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention. Lessons learned A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.
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Affiliation(s)
- Lama Charafeddine
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Saadieh Masri
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Perla Ibrahim
- School of Medicine, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Daniel Badin
- Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Salam Cheayto
- Department of Nursing, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine Clinical Research Institute, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut, Lebanon
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Use of a Midliner Positioning System for Prevention of Dolichocephaly in Preterm Infants. Pediatr Phys Ther 2018; 30:126-134. [PMID: 29579000 DOI: 10.1097/pep.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine effectiveness of a midliner positioning system (MPS, Tortle Midliner) for preventing dolichocephaly. METHODS This was a nonrandomized, prospective study of 30 premature infants (study cohort, SC) using an MPS compared with a retrospective study cohort (RSC) of 65 infants who received standard of care intervention. RESULTS RSC baseline cranial index (CI) of 80% and final CI of 77% significantly decreased over an average 5.5 weeks (P < .0001). The SC baseline CI and the final CI were both 79% over an average 5.7 weeks, indicating no significant difference between CI measures (P = .6). Gestational age, birth weight, reflux, time on continuous positive airway pressure, and time in a supine position were not associated with dolichocephaly. CONCLUSIONS The SC developed less cranial molding (ie, had greater CI), compared with the RSC. A larger randomized study is needed to recommend routine use of MPS for prevention and/or treatment of cranial molding in premature infants.
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Abstract
PURPOSE The purpose is to test the effectiveness of an educational intervention in improving infant positioning because positioning may interfere with neuromotor development. METHODS A quality improvement (QI) project was initiated to increase knowledge and improve the compliance of nurses and physicians in infant positioning using the Infant Positioning Assessment Tool (IPAT). The project was part of Neonatal Individualized Developmental Care Assessment Program (NIDCAP) training. It included informal discussion and practice about infant positions. MAIN OUTCOME VARIABLES Staff knowledge, IPAT score. RESULTS Fifty-two pediatric residents and 39 NICU nurses participated in this project. The mean knowledge assessment test score improved significantly for both nurses (p < .0001) and residents (p < .0001) postintervention; IPAT scores increased significantly from 3.4 (±2. 5) to 8.1 (±2.7) (p < .001). CONCLUSION Nurses' education with hands-on practice improved infant positioning in the NICU; this may lead to fewer positional deformities and possibly an improved developmental outcome.
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Use of the Cranial Cup to Correct Positional Head Shape Deformities in Hospitalized Premature Infants. J Obstet Gynecol Neonatal Nurs 2016; 45:542-52. [DOI: 10.1016/j.jogn.2016.03.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/21/2022] Open
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21
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Kwon DR. Sonographic Analysis of Changes in Skull Shape After Cranial Molding Helmet Therapy in Infants With Deformational Plagiocephaly. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:695-700. [PMID: 26928929 DOI: 10.7863/ultra.15.05029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES -The purpose of this study was to investigate the changes in skull shape on sonography after cranial molding helmet therapy in infants with deformational plagiocephaly. METHODS -Twenty-six infants who were treated with cranial molding helmet therapy were recruited. Caliper and sonographic measurements were performed. The lateral length of the affected and unaffected sides of the skull and cranial vault asymmetry index were measured with calipers. The occipital angle, defined as the angle between lines projected along the lambdoid sutures of the skull, was calculated by sonography. The occipital angle difference and occipital angle ratio were also measured. All caliper and sonographic measurements were performed in each infant twice before and twice after treatment. RESULTS -The study group included 12 male and 14 female infants with a mean age ± SD of 6.2 ± 3.5 months. The mean treatment duration was 6.0 ± 2.5 months. The difference in lateral length before and after helmet therapy was significantly greater on the affected skull than the unaffected skull (16.7 ± 12.7 versus 9.0 ± 13.4 mm; P < .01). The difference in the occipital angle before and after helmet therapy was significantly greater on the affected skull than the unaffected skull (-5.7° ± 7.3° versus 4.2° ± 7.9°; P < .01). The cranial vault asymmetry index and occipital angle ratio were significantly reduced after helmet therapy (cranial vault asymmetry index, 9.3% ± 2.3% versus 3.5% ± 3.0%; occipital angle ratio, 1.07 ± 0.05 versus 1.01 ± 0.01; P < .05). CONCLUSIONS -These results suggest that occipital angle measurements using sonography, combined with cephalometry, could provide a better understanding of the therapeutic effects of cranial molding helmet therapy in infants with deformational plagiocephaly.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea
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22
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Öhman A. A Craniometer with a Headband Can Be a Reliable Tool to Measure Plagiocephaly and Brachycephaly in Clinical Practice. Health (London) 2016. [DOI: 10.4236/health.2016.812128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Akbari MR, Khorrami Nejad M, Askarizadeh F, Pour FF, Ranjbar Pazooki M, Moeinitabar MR. Facial asymmetry in ocular torticollis. J Curr Ophthalmol 2015; 27:4-11. [PMID: 27239567 PMCID: PMC4877722 DOI: 10.1016/j.joco.2015.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Some facial asymmetries are correlated with a history of early onset ocular torticollis supported by the presence of torticollis on reviewing childhood photographs. When present in an adult, this type of facial asymmetry with an origin of ocular torticollis should help to confirm the chronicity of the defect and prevent unnecessary neurologic evaluation in patients with an uncertain history. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging and facial morphometry are helpful for objective diagnosis and measurement of the facial asymmetry, as well as for treatment planning. The facial asymmetry in congenital superior oblique palsy is typically manifested by midfacial hemihypoplasia on the side opposite the palsied muscle, with deviation of the nose and mouth toward the hypoplastic side. Correcting torticollis through strabismus surgery before a critical developmental age may prevent the development of irreversible facial asymmetry. Mild facial asymmetry associated with congenital torticollis has been reported to resolve with continued growth after early surgery, but if asymmetry is severe or is not treated in the appropriate time, it might remain even with continued growth after surgery.
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Affiliation(s)
- Mohammad Reza Akbari
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami Nejad
- Optometry Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Farshad Askarizadeh
- Optometry Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Ranjbar Pazooki
- Optometry Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Reza Moeinitabar
- Optometry Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Cardin AD, Rens L, Stewart S, Danner-Bowman K, McCarley R, Kopsas R. Neuroprotective Core Measures 1–7: A Developmental Care Journey: Transformations in NICU Design and Caregiving Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DeGrazia M, Giambanco D, Hamn G, Ditzel A, Tucker L, Gauvreau K. Prevention of Deformational Plagiocephaly in Hospitalized Infants Using a New Orthotic Device. J Obstet Gynecol Neonatal Nurs 2015; 44:28-41. [DOI: 10.1111/1552-6909.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Öhman A. The Immediate Effect of Kinesiology Taping on Muscular Imbalance in the Lateral Flexors of the Neck in Infants: A Randomized Masked Study. PM R 2014; 7:494-8. [DOI: 10.1016/j.pmrj.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/06/2014] [Accepted: 11/20/2014] [Indexed: 11/27/2022]
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27
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Wright C, Beard H, Cox J, Scott P, Miller J. Parents' choice of non-supine sleep position for newborns: a cross-sectional study. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.9.625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Joyce Miller
- Associate Professor Anglo-European College of Chiropractic Lead Tutor MSc Musculoskeletal Health in Paediatrics Bournemouth University
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Kim JK, Kwon DR, Park GY. A new ultrasound method for assessment of head shape change in infants with plagiocephaly. Ann Rehabil Med 2014; 38:541-7. [PMID: 25229033 PMCID: PMC4163594 DOI: 10.5535/arm.2014.38.4.541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/22/2014] [Indexed: 12/01/2022] Open
Abstract
Objective To compare a new ultrasound measurement method with calliper cephalometry in infants with deformational plagiocephaly (DP) and to assess the differences of two methods according to the severity of DP. Methods Fifty-two infants with DP were divided into two groups according to the degree of cranial vault asymmetry (CVA); group 1 included 42 infants with CVA over 10 mm, and group 2 included 10 infants with CVA under 10 mm. Cranial vault asymmetry index (CVAI) and occipital angle ratio (OAR) were measured by using calliper and ultrasound measurements, respectively. The occipital angle was defined as the angle between the lines projected along the lambdoid sutures of the skull. Results The occipital angles of the affected sides were significantly greater than those of unaffected sides in both groups. The CVAI and OAR were significantly greater in group 1 than in group 2 (CVAI, 9.3%±2.3% vs. 4.6%±1.5%; OAR, 1.05±0.4 vs. 1.01±0.0; p<0.05). The OAR was positively correlated with the CVAI in all infants (r=0.789) and in group 1 (r=0.784; p<0.05). Conclusion Our study revealed that OAR using the new ultrasound measurement was positively correlated with the CVAI in infants with DP. Therefore, the occipital angle measurement using ultrasound combined with cephalometry could provide better understanding about the characteristics of the overall cranial bone and lambdoid suture complex in infants with DP.
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Affiliation(s)
- Jin Kyung Kim
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Gi-Young Park
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography. ScientificWorldJournal 2014; 2014:502836. [PMID: 24688395 PMCID: PMC3933399 DOI: 10.1155/2014/502836] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 12/26/2013] [Indexed: 11/18/2022] Open
Abstract
Cephalic index is a highly useful method for planning surgical procedures, as well as assessing their effectiveness in correcting cranial deformations in children. There are relatively very few studies measuring cephalic index in healthy Caucasian young children. The aim of our study was to develop a classification of current cephalic index for healthy Caucasian children up to 3 years of age with normal brain development, using axial slice computer tomography performed with very thin slices (0.5 mm) resulting in more accurate measurements. 180 healthy infants (83 females and 97 males) were divided into 5 age categories: 0-3, 4-6, 7-12, 13-24, and 25-36 months. The average value of cephalic index in children up to 3 years of age amounted to 81.45 ± 7.06. The index value in case of children under 3 months was 80.19, 4 to 6 months was 81.45, 7 to 12 months was 83.15, in children under 2 years was 81.05, and in children under 3 years was 79.76. Mesocephaly is the dominating skull shape in children. In this study, we formulated a classification of current cephalic indices of children with normal brain development. Our date appears to be of utmost importance in anthropology, anatomy forensic medicine, and genetics.
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Ifflaender S, Rüdiger M, Konstantelos D, Wahls K, Burkhardt W. Prevalence of head deformities in preterm infants at term equivalent age. Early Hum Dev 2013; 89:1041-7. [PMID: 24016482 DOI: 10.1016/j.earlhumdev.2013.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Due to a rising number of head deformities in healthy newborns, there has been an increasing interest in nonsynostotic head deformities in children over recent years. Although preterm infants are more likely to have anomalous head shapes than term newborns, there is limited data available on early prevalence of head deformities in preterm infants. AIMS The purposes of the present study were to acquire quantitative data on head shape of preterm infants at Term Equivalent Age (TEA), to determine the prevalence of symmetrical and asymmetrical head deformities and to identify possible risk factors. METHODS In a cross-sectional study design, Cranial Vault Asymmetry Index (CVAI) and Cranial Index (CI) calculated from routine head-scans with a non-invasive laser shape digitizer were recorded and categorized in type and severity of deformation for three different groups of gestational age. Perinatal and postnatal patient data was tested for possible associations. RESULTS Scans of 195 infants were included in the study. CVAI at TEA was higher in very preterm (4.1%) compared to term and late preterm infants. Prevalence of deformational plagiocephaly was 38% in very preterm infants. CI was lower in very (71.4%) and late (77.2%) preterm infants compared to term infants (80.0%). Compared to term babies (11%), a large number of very (73%) and late (28%) preterm infants exhibited dolichocephaly at TEA. DISCUSSION Prevalence of symmetrical and asymmetrical head deformities in preterm infants is high at TEA. Interventions are required to prevent head deformities in preterm infants during the initial hospital stay.
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Affiliation(s)
- Sascha Ifflaender
- Department of Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany
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Yacoub A, von Salis-Soglio G, Heyde CE. [Correction of pronounced plagiocephaly with orthosis : results of a prospective follow-up control]. DER ORTHOPADE 2013; 42:928-33. [PMID: 24057338 DOI: 10.1007/s00132-013-2171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
For the treatment of pronounced deformational plagiocephaly in infants different therapeutic options are under discussion in the literature. This article presents a prospective observational study of 45 infants enrolled with distinct plagiocephaly and treated with a custom-made helmet orthosis. Treatment with the helmet orthosis was indicated by a difference in the skull diagonals of more than 0.5 cm or a cranial vault asymmetry (CVA) index > 3.5. The follow-up results were controlled with the help of a mobile spatial laser scanner and the CVA index and the skull deformity were measured. The average duration of treatment was 131 days. The CVA index improved from 9.95 to a normal value of 3.35 (median) and the skull deformity improved from 1.3 cm to 0.5 cm (median). The only side effects observed were easily treatable pressure marks. The results of this study reveal that pronounced deformational plagiocephaly can be successfully treated with a custom-made helmet orthosis and closely controlled monitoring.
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Affiliation(s)
- A Yacoub
- Orthopädische Praxis, Taucha, Deutschland
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Abstract
This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Physical therapy intervention in the NICU is infant-driven and focuses on providing family-centered care. In this context, interventions to facilitate a calm behavioral state and motor organization in the infant, address positioning and handling of the infant, and provide movement therapy are presented.
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Affiliation(s)
- Eilish Byrne
- Neonatal Intensive Care Unit, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94304, USA.
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Öhman A. The inter-rater and intra-rater reliability of a modified “severity scale for assessment of plagiocephaly” among physical therapists. Physiother Theory Pract 2011; 28:402-6. [DOI: 10.3109/09593985.2011.639850] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Testing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: a Swedish pilot study. J Pediatr Nurs 2011; 26:541-51. [PMID: 22055374 DOI: 10.1016/j.pedn.2010.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 02/19/2010] [Accepted: 04/13/2010] [Indexed: 11/20/2022]
Abstract
The aim of the study is to test effectiveness of guidelines for nurses that can be incorporated into the child health care program to prevent nonsynostotic plagiocephaly (NSP) in infants while still following sudden infant death syndrome-preventive recommendations. When guidelines were followed as intended in a Swedish pilot study, only 8.5% of infants had some degree of NSP at 6 months, compared to 25.6% of infants in the comparison group. Results indicate that the early and regular implementation of these guidelines by nurses may be an effective way to prevent NSP.
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Positional plagiocephaly: what the pediatrician needs to know. A review. Childs Nerv Syst 2011; 27:1867-76. [PMID: 21614494 DOI: 10.1007/s00381-011-1493-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Positional or deformational plagiocephaly is the most common type of cranial asymmetry in infancy and has become more prevalent after the introduction of the "Back to Sleep" campaign in Western countries. However, the supine position cannot be considered as the only etiologic factor and different predisposing variables have been investigated in the last few years. DISCUSSION The pediatrician should correctly diagnose this condition and exclude the possibility of craniosynostosis in any child with plagiocephaly in order to optimize management and reduce potential morbidity associated with different conditions other than positional ones. In addition, the pediatrician needs to be able to educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary.
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Lennartsson F. Developing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: searching for the evidence. J Pediatr Nurs 2011; 26:348-58. [PMID: 21726785 DOI: 10.1016/j.pedn.2010.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 01/01/2023]
Abstract
The aim of the project was to develop guidelines for nurses that can be incorporated into the Swedish child health care program to prevent nonsynostotic plagiocephaly in infants while still following sudden infant death syndrome preventive measures. Guidelines were developed by reviewing the literature, compiling evidence, appraising recommendations, and formulating a condensed version of relevant information for nurses. The guidelines were tested clinically in a Swedish pilot project.
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Affiliation(s)
- Freda Lennartsson
- Primärvården Skaraborg, Sweden and School of Life Sciences, University of Skövde, Skövde, Sweden.
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Ohman A, Mårdbrink EL, Stensby J, Beckung E. Evaluation of treatment strategies for muscle function in infants with congenital muscular torticollis. Physiother Theory Pract 2011; 27:463-70. [DOI: 10.3109/09593985.2010.536305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anna Ohman
- Department of Physiotherapy, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Stretching treatment for infants with congenital muscular torticollis: physiotherapist or parents? A randomized pilot study. PM R 2011; 2:1073-9. [PMID: 21145518 DOI: 10.1016/j.pmrj.2010.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 08/19/2010] [Accepted: 08/24/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the time needed to achieve a good result in the range of motion (ROM) in the neck for infants with congenital muscular torticollis (CMT). DESIGN Comparison of stretching treatments performed by physical therapists and parents. PARTICIPANTS Twenty infants (10 female and 10 male) with CMT. METHOD The infants were randomly assigned to 1 of 2 groups. Stretching treatment was continued until a good ROM was obtained in both rotation (≥ 90°) and lateral flexion (no side difference). The main outcome measurement was treatment time. The infants were evaluated for ROM in rotation and lateral flexion, muscle function in the lateral flexor muscles of the neck, plagiocephaly, and head tilt. RESULTS The time needed to achieve a good result according to the ROM in the neck was significantly shorter (P < .001) in the physical therapist group than in the parent group. Symmetrical head posture was achieved sooner (P = .03) in the physical therapist group. CONCLUSION Infants with CMT gained good ROM and symmetric head posture approximately 2 months sooner when treated by an experienced physical therapist; however, interpretation of the results of this small study should be guarded. Further studies are needed to confirm these results.
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Sándor GKB, McGuire TP, Ylikontiola LP, Serlo WS, Pirttiniemi PM. Management of facial asymmetry. Oral Maxillofac Surg Clin North Am 2008; 19:395-422, vi. [PMID: 18088893 DOI: 10.1016/j.coms.2007.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asymmetries of the craniofacial region encompass a multitude of diverse and potentially complex abnormalities that may be the result of numerous causes. The expression and degree of asymmetry for a given condition, although a highly variable process, is the ultimate determinant of the nature of its treatment. This article highlights some of the key features and treatment strategies for various common facial asymmetries.
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Affiliation(s)
- George K B Sándor
- Graduate Program in Oral and Maxillofacial Surgery and Anesthesia, University of Toronto, Toronto, Ontario, Canada.
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McManus BM, Capistran PS. A case presentation of early intervention with dolichocephaly in the NICU: collaboration between the primary nursing team and the developmental care specialist. Neonatal Netw 2008; 27:307-315. [PMID: 18807411 DOI: 10.1891/0730-0832.27.5.307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Dolichocephaly, narrow width and long anterior-posterior cranial distance, is more commonly seen in preterm than in term infants. It seems to persist after NJCU discharge and may be a marker for adverse neurodevelopment. This article reports a case of cranial molding in one extremely low birth weight infant. He was placed on a viscoelastic mattress and a twice weekly developmental care program. Cranial molding was measured using the cranial index (CI), a ratio of width to length. Initially, the patient presented with dolichocephaly (CI=72 percent). y week 2, CI measurements approached normal limits (CI=75 percent). When placed on continuous positive airway pressure, the infant presented with substantial dolichocephaly (CI=66.7 percent). Following position changes to midline, CI measurements continued to improve and remained within normal limits until discharge. This dual-element program was feasible, acceptable to parents and staff and may be effective for identifying and managing dolichocephaly.
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Turnage-Carrier C, McLane KM, Gregurich MA. Interface pressure comparison of healthy premature infants with various neonatal bed surfaces. Adv Neonatal Care 2008; 8:176-84. [PMID: 18535423 DOI: 10.1097/01.anc.0000324342.32464.83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to determine interface pressure between the occiput of healthy premature infants and 5 different bed surfaces used in special care nurseries. SUBJECTS Thirteen healthy premature infants comprised the convenience sample enrolled 1 to 3 weeks prior to discharge. DESIGN A quasi-experimental design was used with the dependent variable being the interface pressures obtained under the occiput and the independent variables as the bed surfaces. METHODS Order of bed surfaces was randomized and standardization of the infant positioning and measuring procedure maintained. Measurements were made between the infant's occiput and the bed surface and interface pressures recorded in millimeters of mercury. The 5 bed surfaces were standard crib mattress with or without foam, gel donut, gel mattress, and water pillow. MEASURES Interface pressure measurements were obtained using the Mini-Texas Interface Pressure Evaluator (Mini-TIPE, Tee-Kay Applied Technology, Inc, Stafford, Texas). RESULTS A 1-way blocked analysis of variance was conducted to evaluate the relationship between the mattress surfaces and the interface pressure measurements. A significant difference in the mean of the interface pressures among the 5 mattress bed surfaces was determined, F(4,46) = 33.267, P < .001, with the lowest being the foam overlay. The standard crib mattress had the highest interface pressure that exceeded 100 mm Hg. Post hoc comparisons showed a significant difference between the standard crib mattress with and without foam and the other surfaces. CONCLUSIONS Interface pressure is an important consideration when choosing a support surface for premature infants susceptible to tissue compromise and head molding. Variations in interface pressures between neonatal bed surfaces are apparent. Comparison studies of interface pressures using these and other neonatal bed surfaces will be valuable in determining appropriate products for both premature and neonatal populations with lengthy intensive care stays.
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Mewes AUJ, Zöllei L, Hüppi PS, Als H, McAnulty GB, Inder TE, Wells WM, Warfield SK. Displacement of brain regions in preterm infants with non-synostotic dolichocephaly investigated by MRI. Neuroimage 2007; 36:1074-85. [PMID: 17513129 PMCID: PMC3358776 DOI: 10.1016/j.neuroimage.2007.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 02/26/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022] Open
Abstract
Regional investigations of newborn MRI are important to understand the appearance and consequences of early brain injury. Previously, regionalization in neonates has been achieved with a Talairach parcellation, using internal landmarks of the brain. Non-synostotic dolichocephaly defines a bi-temporal narrowing of the preterm infant's head caused by pressure on the immature skull. The impact of dolichocephaly on brain shape and regional brain shift, which may compromise the validity of the parcellation scheme, has not yet been investigated. Twenty-four preterm and 20 fullterm infants were scanned at term equivalent. Skull shapes were investigated by cephalometric measurements and population registration. Brain tissue volumes were calculated to rule out brain injury underlying skull shape differences. The position of Talairach landmarks was evaluated. Cortical structures were segmented to determine a positional shift between both groups. The preterm group displayed dolichocephalic head shapes and had similar brain volumes compared to the mesocephalic fullterm group. In preterm infants, Talairach landmarks were consistently positioned relative to each other and to the skull base, but were displaced with regard to the calvarium. The frontal and superior region was enlarged; central and temporal gyri and sulci were shifted comparing preterm and fullterm infants. We found that, in healthy preterm infants, dolichocephaly led to a shift of cortical structures, but did not influence deep brain structures. We concluded that the validity of a Talairach parcellation scheme is compromised and may lead to a miscalculation of regional brain volumes and inconsistent parcel contents when comparing infant populations with divergent head shapes.
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Affiliation(s)
- Andrea U J Mewes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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