Three-dimensional assessments versus perceptions of skull deformation in infants

Abstract

In this study by Collett et al, 3-dimensional skull surface imaging was performed in infants at approximately 7 months of age and again at 18 months of age to assess changes in head shape. Infants with deformational plagiocephaly or brachycephaly, diagnosed at the Children's Craniofacial Center in Seattle, constituted the affected case group (n = 233), recruited infants with no evidence of dysmorphology at entry were the unaffected controls (n = 167), and recruited infants (almost 30% of total recruited controls) who, despite having no previous diagnosis of skull dysmorphology, had such at entry were assigned as affected controls (n = 70). Planned exclusions in the affected group (eg, prematurity, underlying neurodevelopment condition, other malformations) led to entry of only 52% of screened patients, yet the group studied constituted an important clinical group. Thirty-five percent of affected infants received orthotic helmet therapy (not as part of the study protocol). Multiple measurements were taken at the entry visit and again at 18 months of age, yielding an absolute asymmetry score, among other data points, as well as calculated “Z scores” in order to express change over time. At the 18-month visit, affected cases and affected controls still had greater skull flattening and asymmetry compared with unaffected controls; however, head shapes became less flat and more symmetric (ie, “improved”) over time. Among affected cases, symmetry, but not posterior flattening or brachycephaly, improved slightly more in those who received orthotic treatment. In addition to the results above, the authors noted that overall skull symmetry (rather than recorded dimensional measurements) may be more important than the subjective perception of clinicians, parents, and adult lay observers in assessing “deformity” per se and “goodness” of outcome over time. Article page 673▶ Longitudinal, Three-Dimensional Analysis of Head Shape in Children with and without Deformational Plagiocephaly or BrachycephalyThe Journal of PediatricsVol. 160Issue 4PreviewTo assess 3-dimensional (3D) changes in head shape in infancy and at age 18 months in children with and without plagiocephaly or brachycephaly. Full-Text PDF