The Course Of Skull Deformation From Birth To 5 Years Of-PDF Free Download

The course of skull deformation from birth to 5 years of
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12 Eur J Pediatr 2017 176 11 21, cosmetic condition 11 20 Hutchison et al reported that. What is Known, Skull deformation prevalence increased after recommendations against 4 of skull deformations remained severe at 3 to 4 years. Sudden Infant Death Syndrome little is known about the longitudinal of age 20 In a cross sectional study Roby et al found a. course prevalence of DP of 1 and DB of 1 1 in 15 year old. Paediatric physical therapy intervention between 2 and 6 months of age teens 33 Of these children with DP or DB 38 1 was. reduces deformational plagiocephaly at 6 and 12 months of age. noted to have abnormal facial characteristics 33, What is New. The course of skull deformation is favourable in most of the children in In children with DP and DB several conservative interven. The Netherlands at 5 years of age deformational brachycephaly is tions are applied paediatric physical therapy 5 9 43 hel. within the normal range for all children whereas the severity of met therapy 18 24 27 32 36 37 46 manual therapy 8. deformational plagiocephaly is within the normal range in 80 osteopathy 35 and surgical intervention 22 30. within the mild range in 19 and within the moderate to severe range. in only 1 The aim of the present study was to investigate the long. Paediatric physical therapy intervention does not influence the term course of skull shape in healthy newborns until the age of. long term outcome it only influences the earlier decrease of the 5 5 years with special interest in the subgroups of children. severity of deformational plagiocephaly with and without positional preference at 7 weeks and in the. children with positional preference who received paediatric. physical therapy intervention PPT or not no PPT, Keywords Deformational brachycephaly Deformational. plagiocephaly Newborns Skull deformation, Abbreviations.
CPI Cranio proportional index This study provides additive follow up data of a prospective. DB Deformational brachycephaly cohort study with an embedded randomised controlled trial to. DP Deformational plagiocephaly assess the effect of paediatric physical therapy with measure. ODDI Oblique diameter difference index ments at birth 7 weeks 6 and 12 months of age The additive. PCM Plagiocephalometry data of the measurements in children at 2 and 5 5 years of age. PPT Paediatric physical therapy intervention are presented in this article. Introduction Participants, Since epidemiological studies have showed that prone and The original prospective cohort study started with 380. side sleeping were major risk factors for sudden infant healthy newborns 36 weeks gestation born between. death syndrome SIDS 12 14 supine sleeping has in December 2004 and September 2005 at the general dis. creased consistent with the recommendations of the trict hospital Bernhoven in Veghel The Netherlands. American Academy of Paediatrics 2 3 13 15 Children with congenital muscular torticollis torticollis. Simultaneously a prevalence increase of skull deforma with a one sided shortening of the sternocleidomastoid. tion has also been observed 4 6 7 19 29 asymmetri muscle Kaplan type 2 and 3 23 39 40 dysmorphism. cally this is described as deformational plagiocephaly or syndromes were excluded A flowchart of included and. DP and or symmetrically which is described as defor excluded children over time is presented in Fig 1 At. mational brachycephaly DB 4 19 32 34 7 weeks of age the embedded randomised controlled trial. The prevalence of DP and DB increases rapidly in started and the cohort of children was divided into three. young children during the first months of life 19 21 groups 1 children without positional preference. 34 39 DP is attributed to perinatal factors 16 21 26 n 315 2 children with positional preference. 34 39 as well as factors in early infancy 6 17 19 39 n 65 and randomly allocated to PPT n 33 and. Familial and ethnic factors are supposed to be related to 3 children with positional preference and randomly al. skull deformations 25 31 34 Positional preference located to no PPT n 32 Results of the RCT until the. when children lie on their back is the major cause of age of 12 months are presented elsewhere PPT between 2. these skull deformations 4 7 19 34 children keep their and 6 months of age was established to be effective in. head turned with the same spot on the surface which children with positional preference in reducing DP at 6. slows down growth in that direction and stimulates and 12 months of age 42 43 Therefore we decided to. growth in the other directions 4 7 18 34 Many clini present the long term outcome at 2 and 5 5 years for the. cians consider skull deformation to be a minor and purely three above mentioned subgroups. Eur J Pediatr 2017 176 11 21 13, Fig 1 Flowchart of the children 2004 2005 T0 birth initial cohort n 400. assessed six times from birth to, 5 5 years of age Dropout 15 Total out T0 T1 20. 10 Insufficient parental motivation 1, 4 Not traceable not yet divided into subgroups. 1 Family circumstances 2, Exclusion 5, 5 Concomitant disease 3.
2005 T1 7 weeks of age n 380, Dropout 20 Total out T1 T2 20. 8 Insufficient parental motivation 1 Group 1 20, 2 Not traceable Group 2 0. 10 Parents chose to quit the study 4 Group 3 0, 2005 2006 T2 6 months of age n 360. Dropout 16 Total out T2 T3 17, 7 Insufficient parental motivation 1 Group 1 14. 3 Not traceable Group 2 2, 4 Moved out of the region Group 3 1.
2 Parents chose to quit the study 4, Exclusion 1, 1 Concomitant disease 3. 2005 2006 T3 12 months of age n 343, Dropout 30 Total out T3 T4 31. 4 Insufficient parental motivation 1 Group 1 28, 24 Not traceable Group 2 2. 2 Moved out of the region Group 3 1, Exclusion 1, 1 Concomitant disease 3. 2006 2007 T4 24 months of age n 312, Dropout 62 Total out T4 T5 64.
34 Insufficient parental motivation 1 Group 1 51, 14 Not traceable Group 2 8. 4 Moved out of the region Group 3 5, 6 Family circumstances 2. 4 Fear of the child for the assessment, Exclusion 2. 2 Concomitant disease 3, Total out T0 T5 152, 2010 2011 T5 5 5 years of age n 248 T0 T5 Group 1 113. Dropouts 143 Group 2 12, Complete data set for the linear mixed model Exclusions 9 Group 3 7.
1 Insufficient parental motivation repeated cancellations too busy. 2 Family circumstances divorced parents severe illness of one parent. 3 Concomitant disease later diagnosed and excluded based on the exclusion criteria. 4 Parents chose consciously to quit the study preferred intervention. Measures gestation pregnancy rank presentation at delivery mode of. delivery length of labour multiple birth Apgar score birth. Participating children were measured at birth T0 7 weeks weight and birth head circumference were collected within. T1 6 months T2 and 12 months T3 Long term outcome 48 h of birth. data were collected at 24 months T4 and 5 5 years T5 of age Gender being firstborn nursing feeding sleeping and. playing positioning habits positional preference when. General characteristics and risk factors sleeping head to the same side on a chest of drawers. only bottle feeding positioning to the same side during. General characteristics including gender birth rank parental bottle feeding tummy time when awake 3 times per. age parental educational level and obstetric data including day and slow achievement of motor milestones with the. 14 Eur J Pediatr 2017 176 11 21, presence of DP were considered as potential risk factors groups received regular advice from well baby clinics. based on a previous study 42 like every child in The Netherlands 43. Primary outcome measure, Statistics, The transversal shape of the skull was measured at all six. Descriptive statistics were used to analyse baseline char. assessments T0 T5 by plagiocephalometry PCM, acteristics Means and standard deviations or proportions. which is a reliable valid and responsive instrument 27. were calculated for the relevant variables In the present. 38 41 PCM measures the relationship between the, study we assessed the association between peri and post. transverse shape of the skull and the position of both ears. natal factors and skull deformation data at 7 weeks of age. and nose and thereby the location and amount of flatten. with the skull deformation at 24 months and 5 5 years of. ing of the skull PCM assesses the severity of DP by the. age The relationship between these factors and deformity. parameter oblique diameter difference index ODDI ratio. was analysed by means of cross tabulation as well as. between both oblique diameters of the head and the se. linear and logistic regression In the univariate analyses. verity of DB by the parameter cranio proportional index. putative risk factors with a P 0 15 were selected for. CPI ratio between the width and length of the head. inclusion in multivariate models In the linear regression. Based on psychometric analysis in a previous study 41. analysis the effect of these factors on the dependent fac. and analogous to other relevant studies 44 45 we, tors ODDI continuous and CPI continuous was.
showed that clinically relevant asymmetrical DP skull. assessed at 24 months and 5 5 years of age, flattening was present in the case of ODDI 104 and. To describe the primary outcome measures ODDI and, symmetrical DB skull flattening was present in the case. CPI two linear mixed models were constructed One, of CPI 90 Furthermore we defined four categories of. model had ODDI as the dependent variable related to. skull deformation whereas ODDI refers to DP and CPI. DP and the other had CPI as the dependent variable. refers to DB 1 normal ODDI 104 and or CPI 90 2, related to DB We included time positional preference. mild ODDI 104 107 and or CPI 90 94 3 moderate, at 7 weeks of age and the outcome measures ODDI and.
ODDI 108 111 and or CPI 95 99 and 4 severe ODDI, CPI at birth as independent variables The models with. 112 and or CPI 100, the three subgroups as illustrated in the design includ. PCM was performed by two very experienced examiners. ed interactions between positional preference and mea. who were blinded for the group belonging and who were. surements in time This time by positional preference. interchangeable LV author FG acknowledgements, interaction showed whether there was a difference be. 41 43 The environmental conditions temperature light. tween the groups over the study period Time positional. positioning during the assessments were the same for all. preference at 7 weeks of age independent ODDI or CPI. variables at birth and the interaction term between po. sitional preference and time were all entered in the. Paediatric physical therapy intervention models as fixed factors The ODDI pattern is based on. a chosen ODDI at birth of 101 The CPI pattern is, In 65 children with positional preference PPT was indi based on a chosen CPI at birth of 79. cated as described previously 43 In 33 children a Residual plots from the mixed models were examined to. standardised PPT program was executed due to check model assumptions Both linear mixed model analyses. randomisation of the study between 2 and 6 months of were performed on the three subgroups. age The PPT program consisted of exercises to reduce The mean 95 confidence interval ODDI or CPI were. positional preference and to stimulate motor development computed at each time point for each group for a given value. by counselling parents on positioning handling and nurs of the ODDI and CPI at birth These parameters also enabled. ing supported by a leaflet with basic preventive advice us to estimate the difference between the three positional pref. PPT was stopped when the positional preference no lon erence groups at each time point corrected for the score of the. ger occurred during the day and night when awake and dependent variable at birth Although not all parameters in. asleep when the parents were shown to have incorporated both models showed a significant difference from 0 we kept. all of the advice and exercise in daily handling and when all variables in the model for reasons of consistency. there were no indications for motor developmental prob Analyses were executed as two tailed with a significance. lems delays or asymmetries The parents of the control level of 5 When applicable 95 confidence intervals were. group no PPT received only a leaflet with basic preven computed Statistical analyses were performed using SAS. tive advices without further education to intervene Both software version 9 2 and IBM SPSS Statistics 20 0 software. Eur J Pediatr 2017 176 11 21 15, Results Risk factors identified at 7 weeks of age.
General characteristics of the study population There was no association between the potential risk factors. nursing feeding sleeping and playing positioning habits at. We included 380 healthy newborns in the cohort and 7 weeks of age and skull deformity at 24 months and 5 5 years. assessed them shortly after birth Of these 248 children of age At 24 months of age there was a univariate association. 65 with a mean age of 5 51 years standard devia between the time spent playing prone tummy time mea. tion 0 19 years were analysed at T5 there were 202 sured at 7 weeks of age and the ODDI percentage 0 304. children without positional preference 21 children with P 0 062 95 CI 0 624 to 0 015 In the univariate. positional preference allocated to PPT and 25 children analyses no putative risk factors with a P 0 15 could be. ORIGINAL ARTICLE The course of skull deformation from birth to 5 years of age a prospective cohort study Leo Avan Vlimmeren1 2 amp Raoul HH Engelbert3 4 amp Maaike Pelsma1 2

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