Significant Factors in Cranial Remolding Orthotic Treatment of Asymmetrical Brachycephaly.

Tiffany Graham,Jijia Wang,Elizabeth O’Briant,Madison Oldham,Shacoya Smith,Kelly Millay,Beverley Adams-Huet

doi:10.3390/jcm9041027

Abstract

This retrospective chart review focuses on determining the most effective time to begin cranial remolding orthosis (CRO) treatment for infants with asymmetrical brachycephaly. Subjects with asymmetrical brachycephaly started CRO treatment between 3 and 18 months of age. These infants had a cranial vault asymmetry index (CVAI) ≥ 3.5 and a cranial index (CI) ≥ 90. Subjects were excluded if they had any comorbidities affecting growth, dropped out of treatment, were lost to follow-up, or were noncompliant. Factors which were found to statistically influence treatment outcomes were subject initial age, initial CVAI, and initial CI. Overall, younger subjects were more likely to achieve a corrected head shape. The presence of prematurity or torticollis had statistically nonsignificant effects on the success of treatment. Initial CI was found to be a stronger predictor than initial CVAI as to which subjects achieved correction. The less severe the starting CI, the more likely the subject was to achieve full correction. The clinical understanding is that it requires more cranial growth to “round out” a full posterior skull flattening than an asymmetry. Based on the study results, infants with asymmetrical brachycephaly should be treated as early as possible to increase chances of achieving full correction of the deformity.

Highlights

Skull deformations reportedly affect around 45% of newborn babies [1] and can either be acquired congenitally or during infancy
This is a way to visualize where the subjects fell on the combination of both scales (CI severity for posterior flattening and Cranial Vault Asymmetry Index (CVAI) for asymmetry)
It has an area under the curve of 0.89 with a 95% confidence interval of (0.87, 0.92). This high area under the curve illustrates that this study likely identified the most significant factors in the success of cranial remolding orthosis (CRO) treatment for asymmetrical brachycephaly

Summary

Introduction

Skull deformations reportedly affect around 45% of newborn babies [1] and can either be acquired congenitally or during infancy Many skull deformations, such as plagiocephaly and brachycephaly, are acquired after the baby is born and are classified as positional skull deformities. Asymmetrical brachycephaly is characterized by a posterior flattening of the occiput as well as an asymmetry with compensatory posterior bossing contralaterally. These deformities are caused by external pressures on the baby’s skull when the skull is in the same position for extended periods of time [1,2,3,4,5]. This relatively common occurrence is often attributed to the American Academy of Pediatrics “Back to Sleep” campaign, which recommended infants be placed supine to sleep

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Discussion

Conclusion