Clinical Classification of Infant Nonsynostotic Cranial Deformity

• Published in: The Journal of pediatrics 2012-12, Vol.161 (6), p.1120-1125.e1
• Main Authors: Wilbrand, Jan-Falco, MD, DMD, Schmidtberg, Kerstin, DMD, Bierther, Uta, MD, DMD, Streckbein, Philipp, MD, DMD, Pons-Kuehnemann, Joern, PhD, Christophis, Petros, MD, PHD, Hahn, Andreas, MD, PHD, Schaaf, Heidrun, MD, DMD, PHD, Howaldt, Hans-Peter, MD, DMD, PHD
• Format: Article
• Language: English
• Subjects: Age Distribution; anthropometric measurements; Biological and medical sciences; Cephalometry; childhood; children; Cluster Analysis; Cohort Studies; Cross-Sectional Studies; Databases, Factual; deformation; Female; General aspects; head; Humans; Infant; Infant, Newborn; Male; Medical sciences; Orthotic Devices; Pediatrics; Pilot Projects; Plagiocephaly, Nonsynostotic - classification; Plagiocephaly, Nonsynostotic - diagnosis; Plagiocephaly, Nonsynostotic - therapy; Prospective Studies; Reference Values; Severity of Illness Index; Sex Distribution; statistical analysis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.05.023

Objective Based on a pilot study including >400 children and a comprehensive database analysis of >2500 children, we sought to define the craniofacial norm and to objectify the categorization of positional head deformity. Study design A database was created containing clinical information on children assessed for nonsynostotic cranial deformity. The findings of standardized anthropometric measurements were compared with data from a group of 401 healthy children with a normal head shape collected in terms of a prospective pilot study. Using a statistical analysis of all anthropometric craniofacial measurements, cut-off percentiles for discriminating different groups of deformation and severity classes were generated. Results Normative percentiles for all dimensions in cranial vault anthropometric measurements during the first year of life were calculated. Children with definite nonsynostotic head deformity could be clearly allocated into 3 different groups: positional plagiocephaly (abnormal Cranial Vault Asymmetry Index), positional brachycephaly (abnormal Cranial Index), and combined positional plagiocephaly and brachycephaly (abnormal Cranial Vault Asymmetry Index and Cranial Index). Additionally, a reliable 3-level severity categorization (mild, moderate, and severe) for each group of cranial deformation could be obtained according to age and sex. Conclusions Our results allow a meaningful and reliable classification of nonsynostotic early childhood cranial deformity.