S1-01SESSION 1: NEUROSURGERY UPDATING CEPHALIC INDEX NORMS IN A DIVERSE URBAN PATIENT POPULATION AFTER THE BACK TO SLEEP CAMPAIGN: AN EPIDEMIOLOGIC STUDY

Abstract

Introduction: Cephalometry has a robust history in medicine. Canadian plastic surgeon Leslie Farkas used the head measurements of North American and Western European Caucasian children in the 20th century to establish CI norms that are continually referenced in craniofacial surgery research and outcomes. In 1992, the Back to Sleep Campaign was instituted by the American Academy of Pediatrics and positional plagiocephaly incidence has subsequently increased at least 5-fold. Orthotic helmets are recommended for severe deformities. Insurers have criteria for helmet authorization based on deviations from Farkas normative CI. Our epidemiological study evaluates whether CI values of infants and children have changed since the Back to Sleep Campaign and establishes updated population wide CI norms in a diverse sample of patients at multiple ages. Methods: All patients presenting for a well child check between June 2018 and September 2018 at a single academic institution were screened. Patients were eligible for participation if they were in one of five age groups. Anteroposterior diameter (APD) and biparietal diameter (BPD) measurements were obtained with calipers and head circumference was measured with a tape measure. Interrater reliablity of research associates was performed. Mean BPD and APD, head circumference, and CI for each age group were calculated. A subgroup analysis was further completed for these values by gender and race. Students t tests were used to compare mean CI of patients in this data set to those in comparable age groups in the Farkas data set. An ANOVA was used to assess CI means between racial groups. Results: A total of 532 patients met inclusion criteria. In our sample of children under 6 months, n= 51(57.3%) of the boys and n= 53(45.32%) of girls meet current criteria for a helmet (See Graphic) At 9–12 months, a sample of 81 patients have a CI of 0.84 (SD 0.061). This value was stable at 2–3 years of age. The CI mean is significantly greater in this patient population at all age ranges and for both genders in comparison to the Farkas data set (p<0.001). Our population includes a diverse sample with 43 Asian patients, 170 Hispanic patients, and 116 Black or African American patients. Conclusion: The mean cephalic index of healthy children in this sample aged 0–1 month and 4–6 months is 0.83 and 0.86, respectively. These values are higher than previously established mean CI values for children under 6 months of .737(males) and .733 (females) by Farkas, demonstrating a global change in CI after the introduction of the Back to Sleep Campaign. Our study provides more current data for craniofacial surgeons when they consider helmet therapy for babies with positional plagiocephaly.