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King HH, Mai J, Morelli Haskell MA, Wolf K, Sweeney M. Effects of osteopathic manipulative treatment on children with plagiocephaly in the context of current pediatric practice: a retrospective chart review study. J Osteopath Med 2024; 124:171-177. [PMID: 37999741 DOI: 10.1515/jom-2023-0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
CONTEXT Deformational plagiocephaly (DP) is on the rise in pediatric patients. The current standard of care recommended for management is repositioning with possible addition of cranial orthoses. However, strong data are lacking to support these recommendations. Osteopathic manipulative treatment (OMT) is another treatment option for DP that is also lacking evidential support. OBJECTIVES This retrospective chart review study investigated the effects of OMT at restoring a more symmetrical cranial bone configuration in children with DP. METHODS A retrospective chart review was performed on medical records of patients with a diagnosis of DP from three private practices over a 4-year period from September 2017 to December 2021. Inclusion criteria were diagnoses of DP by a referring physician and aged 10 months or less at the time of initial evaluation and treatment. Patients were excluded if they had confounding diagnoses such as genetic syndromes or severe torticollis. A total of 26 patients met these criteria, and their records were reviewed. The main outcome reviewed was anthropometric assessment of the cranium, mainly the cranial vault asymmetry index (CVAI). RESULTS Participants demonstrated a mean CVAI - a measure that determines the severity of DP - of 6.809 (±3.335) (Grade 3 severity) at baseline, in contrast to 3.834 (±2.842) (Grade 2 severity) after a series of OMT treatments. CVAI assessment after OMT reveals statistically significant (p≤0.001) decreases in measurements of skull asymmetry and occipital flattening. No adverse events were reported throughout the study period. CONCLUSIONS The application of OMT has shown potential benefit for reducing cranial deformity in patients with DP.
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Affiliation(s)
- Hollis H King
- University of California San Diego School of Medicine, Center for Integrative Medicine, San Diego, CA, USA
| | - Julie Mai
- Osteopathy's Promise to Children, San Diego, CA, USA
| | | | - Kimberly Wolf
- Osteopathic Manipulative Medicine Department, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Megan Sweeney
- Osteopathy's Promise to Children, San Diego, CA, USA
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McMahon MJ, Evanovich DM, Pier DB, Kagan MS, Wang JT, Zendejas B, Jennings RW, Zurakowski D, Bajic D. Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure. Birth Defects Res 2024; 116:e2269. [PMID: 37936552 DOI: 10.1002/bdr2.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/04/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is limited knowledge regarding the impact of perioperative critical care on frequency of neurological imaging findings following esophageal atresia (EA) repair. METHODS This is a retrospective study of infants (n = 70) following EA repair at a single institution (2009-2020). Sex, gestational age at birth, type of surgical repair, underlying disease severity, and frequency of neurologic imaging findings were obtained. We quantified the length of postoperative pain/sedation treatment and anesthesia exposure in the first year of life. Data were presented as numerical sums and percentages, while associations were measured using Spearman's Rho. RESULTS Vertebral/spinal cord imaging was performed in all infants revealing abnormalities in 44% (31/70). Cranial/brain imaging findings were identified in 67% (22/33) of infants in the context of clinically indicated imaging (47%; 33/70). Long-gap EA patients (n = 16) received 10 times longer postoperative pain/sedation treatment and twice the anesthesia exposure compared with short-gap EA patients (n = 54). The frequency of neurologic imaging findings did not correlate with underlying disease severity scores, length of pain/sedation treatment, or cumulative anesthesia exposure. Lack of associations between clinical measures and imaging findings should be interpreted with caution given possible underestimation of cranial/brain findings. CONCLUSIONS We propose that all infants with EA undergo brain imaging in addition to routine spinal imaging given the high burden of abnormal brain/cranial findings in our cohort. Quantification of pain/sedation and anesthesia exposure in long-gap EA patients could be used as indirect markers in future studies assessing the risk of neurological sequelae as evidenced by early abnormalities on brain imaging.
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Affiliation(s)
- Maggie Jean McMahon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Devon Michael Evanovich
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Danielle Bennet Pier
- Division of Pediatric Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Mackenzie Shea Kagan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell William Jennings
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Park KE, Chandler L, Ahmad M, Singh A, Allam O, Mets E, Bridgett DJ, Persing JA, Alperovich M. Neurocognitive Outcomes in Deformational Plagiocephaly: Is There an Association between Morphologic Severity and Results? Plast Reconstr Surg 2023; 152:488e-498e. [PMID: 36847664 DOI: 10.1097/prs.0000000000010330] [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] [Indexed: 03/01/2023]
Abstract
BACKGROUND The neurodevelopmental effects of skull asymmetry and orthotic helmet therapy for deformational plagiocephaly (DP) have had limited investigation. This study assessed the long-term neurocognitive outcomes in patients with DP and their association with orthotic helmet therapy and head shape abnormality. METHODS A total of 138 school-age children with a history of DP, 108 of whom received helmet therapy, were tested with a neurocognitive battery assessing academic achievement, intelligence quotient, and visual-motor function. Severity of presenting plagiocephaly was calculated using anthropometric and photometric measurements. Analysis of covariance was used to compare outcomes between helmeted and nonhelmeted cohorts, unilateral plagiocephaly and concomitant brachycephaly, and left-sided and right-sided plagiocephaly. The association between severity of plagiocephaly and neurocognitive outcome was assessed through a residualized change approach. RESULTS There were no significant differences in neurocognitive outcomes between the helmeted and nonhelmeted DP cohorts or the unilateral plagiocephaly and brachycephaly cohorts. Participants with left-sided DP had significantly lower motor coordination scores than participants with right-sided DP (84.8 versus 92.7; effect size = -0.50; P = 0.03). There was a significant laterality by cephalic index interaction, with a negative association between cephalic index and reading comprehension and spelling for participants with left-sided DP. No significant associations were found between severity of presenting or posttreatment deformity and neurocognitive outcome. CONCLUSIONS Pretreatment and posttreatment severity of plagiocephaly were not correlated with neurocognitive function at school age. Helmet therapy was not associated with better or worse long-term neurocognitive function. However, participants with left-sided DP demonstrated worse neurocognitive outcomes than participants with right-sided DP in the domains of motor coordination and some types of academic achievement. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Kitae E Park
- From the Yale University School of Medicine
- The Johns Hopkins Hospital
| | | | | | | | - Omar Allam
- From the Yale University School of Medicine
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Huang T, Li W, Wang C, Qu F, Yang Q, Pan Q, Pu X, Xiao C, Cai Y, Xia M, Zhang Y. Research into the correlation between positional skull deformation and motor performance of infants aged under 4 months. BMC Pediatr 2023; 23:212. [PMID: 37143034 PMCID: PMC10157931 DOI: 10.1186/s12887-023-03959-6] [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: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To investigate the correlation between positional skull deformation (PD) and motor performance of infants under 4 months of age. METHODS Infants aged under 4 months were enrolled in the children's healthcare and the premature infants follow-up Clinic of the Second Affiliated Hospital of Army Military Medical University. The cranial vault asymmetry (CVA) and cephalic index (CI) were calculated in all infants, and the infant motor performance test (TIMP) was used to evaluate the infant motor performance. The motor performances of infants with different types and degrees of PD were compared, so were the incidences of PD in infants with different motor performance levels. RESULTS Overall, 2118 infants were recruited and divided according to the types of PD and TIMP scores. The comparison of TIMP scores within different types of PD at different months of age showed that, regardless of the types of PD, TIMP scores of infants with PD were lower than those of normal infants. In particular, the difference in TIMP scores was statistically significant (P < 0.05) in infants with dolichocephaly, plagiocephaly,dolicho-plagiocephaly and brachy-plagiocephy. In addition, the comparison of CVA values of infants with different TIMP score levels at different months of age showed that the CVA values of the extremely low-level group were significantly higher than those of the medium-level and high-level group, especially in the 3-month-old and 4-month-old groups, which showed significant statistical differences (P < 0.05). CONCLUSIONS PD and motor performance of infants aged under 4 months seem to interact and influenc each other. The more serious the severity of PD were,the worse the motor performance of infants. Conversely, the incidence of PD increased in infants with poor motor performance.
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Affiliation(s)
- Tianqi Huang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Wenzao Li
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Chengju Wang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Fuxiang Qu
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Qiuxia Yang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Qiuming Pan
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Xiaoqin Pu
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Can Xiao
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Yi Cai
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Meifeng Xia
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China
| | - Yuping Zhang
- Department of Pediatrics, the Second Affiliate Hospital of Army Medical University, No. 83 Xinqiao Street, Chongqing, 400037, China.
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Chow I, Brisbin AK, Anstadt EE, Goldstein JA, Losee JE. Delayed Presentation of Unicoronal Craniosynostosis-Masked by Ipsilateral Posterior Deformational Plagiocephaly. Cleft Palate Craniofac J 2022; 60:768-772. [PMID: 35195470 DOI: 10.1177/10556656221080996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite a greater awareness of the differential diagnosis of head shape abnormalities among pediatricians, the effect of deformational forces on calvarial morphology can complicate the diagnosis of craniosynostosis. In this report, we describe 2 patients diagnosed with unicoronal craniosynostosis (UCS) in a delayed fashion due to the presence of concomitant posterior deformational plagiocephaly (PDP). In both cases, the severity of each patients' PDP obscured changes typically associated with UCS. This unique presentation underscores the importance of having a high index of suspicion for possible premature suture fusion despite the presence of concomitant PDP.
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Affiliation(s)
- Ian Chow
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alyssa K Brisbin
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erin E Anstadt
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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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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