Cranial Shape in Infants Aged One Month Can Predict the Severity of Deformational Plagiocephaly at the Age of Six Months

Abstract

In this study, we aimed to monitor changes in cranial shape using three-dimensional (3D) scanning to determine whether the severity of deformational plagiocephaly (DP) at the age of 6 months could be predicted at the age of 1 month. The cranial shape was measured at the ages of 1, 3, and 6 months (T1, T2, and T3, respectively) in 92 infants. We excluded those who received helmet treatment before T3. The cranial vault asymmetry index (CVAI) using 3D scanning was evaluated in all infants. DP was defined as a CVAI > 5.0% with mild (CVAI ≤ 6.25%) or moderate/severe severity (CVAI > 6.25%). The CVAI cut-off value at T1 for severe DP at T3 was determined using receiver operating characteristic (ROC) curves. At T1, T2, and T3, the respective CVAI median values were 5.0%, 5.8%, and 4.7% and the DP incidence was 50.0%, 56.8%, and 43.2%, respectively. The DP severity temporarily worsened from T1 to T2 but then improved at T3. Among the infants, 73.9% had a similar DP severity at T1 and T3 (p = 1.0). A ROC curve analysis revealed a CVAI cut-off value of 7.8% at T1 predicted severe DP. It was concluded that later DP severity could be predicted using 3D scanning at T1 with properly defined cut-off values.

Evaluating Cranial Growth in Japanese Infants Using a Three-dimensional Scanner: Relationship between Growth-related Parameters and Deformational Plagiocephaly

“…Previous report shows that DP exacerbates until 3 months of age before spontaneously improving throughout the first 6 months of life. 10) We have also reported that helmet therapy could improve CA three times better than spontaneous recovery. 22) These facts could be important determinants in the decision-making process for the indications for helmet therapy for DP.…”

“…However, because we excluded children with severe DP who were indicated for helmet therapy, future studies should include children with severe DP. In this study, we included six patients (6.8%) with severe DP with CVAI > 8.75% 10 ) at 6 months. Peterson et al compared DP infants with and without helmet therapy and reported no significant differences in final CrV.…”

“…In our previous report, we found that the incidence of DP is high among Japanese infants, with approximately 5% of healthy infants requiring helmet therapy. 10 , 11 ) Concerns that the number of infants requiring cranial correction will increase in the future and that the limited availability of 3D scanners will delay accurate diagnosis have already been raised. Early registration of handheld 3D scanners as medical devices is therefore desirable.…”

“…In this study, we aimed to examine different parameters, with data obtained at the same time points as those used in previous reports on symmetry-related parameters. 10 ) The study protocol was approved by the Ethics Committee of each institution (Kasukabe Medical Center, Hikawadai Noto Clinic: approval no. 2019-032; Nihon University Itabashi Hospital: approval no.…”

“…Although databases for longitudinal 3D scanner measurements of infant head shapes have been established overseas, [5][6][7] reports describing similar shape trends in normal Japanese infants are based on CT. 8,9) We have previously reported changes in symmetry-related parameters such as cranial asymmetry (CA), the cranial vault asymmetry index (CVAI), anterior symmetry ratios, and posterior symmetry ratios using a 3D scanner from 1 to 6 months of age and found that the incidence of symmetry-related parameters and deformational plagiocephaly (DP) worsened up to 3 months of age and then improved over the next 3 months. 10) In that study, we examined the trends in growth-related parameters and identified the need to clarify the relationship between DP and growth-related parameters. Therefore, in this study, we aimed to evaluate 3D data of the cranial shape of healthy Japanese infants, longitudinally evaluate growth in each of the three dimensions, and construct a database of normal values.…”