Defining the nature and implications of head turn preference in the preterm infant

Abstract

Aim To determine the relationship of head turn preference in the preterm infant to: 1) perinatal medical factors, 2) neonatal neurobehavior, and/or 3) infant neurodevelopmental outcomes. Methods Seventy preterm infants born ≤30 weeks gestation were enrolled at birth. Detailed information regarding neonatal intensive care unit (NICU) medical course was compiled for each infant. Neurobehavioral testing was performed during NICU hospitalization. Head turn preference was quantified at term equivalent age using a newly developed scale. Infants returned at age two years for standardized developmental testing. Results All infants demonstrated a head turning preference, with most preferring the right side (n = 51, 77%). Fifty-five infants (79%) had moderate to severe head turn preference. Head turn preference was associated with 1) medical severity (hours of inotrope use, p = 0.02; oxygen requirement at 36 weeks postmenstrual age, p = 0.03), 2) worse neurobehavioral performance (decreased self-regulation, p = 0.007; more sub-optimal reflexes p = 0.006), and 3) worse developmental outcome at age two years (poorer fine motor, p = 0.02). Interpretation Medical factors in the NICU appear to be associated with the development of a head turn preference. Increased severity of head turn preference may be a marker for poor developmental outcome. Early identification may inform therapeutic interventions designed to minimize symptoms and optimize neurodevelopmental outcome.

A 3D Follow-Up Study of Cranial Asymmetry from Early Infancy to Toddler Age after Preterm versus Term Birth

“…The head orientation profile of healthy full-term infants normally changes from lateral head orientation to midline orientation in three to nine weeks after birth, and a delay in that maturation seems to associate with DP [31]. Accordingly, head turn preference at TEA in preterm infants has been associated with DP, but also with the severity of medical comorbidities and poor neurobehavioral performance [19,32,33,34].…”

“…It is known that DP may take a long time to resolve [28,36], and sometimes it may be permanent, as Ruby et al report the prevalence of deformational cranial abnormalities to be 2% in teens born after the ‘Back to Sleep’ campaign [36]. Furthermore, although DP is usually transient, it may be associated with delayed motor development or torticollis [11,13,33,34]. DP also associates with a rotation of the cranial base and the anterior displacement of the articular fossa on the affected side, which is hypothesized to cause facial asymmetry [37,38,39].…”

Ontogenesis of Lateralization

“…The lateralized curled position of the bird embryo is very likely mediated by the Nodal cascade, as the processes underlying the asymmetrical positioning of the viscera are always accompanied by torsion of the embryo and a turn of the head to the right (Ramsdell and Yost, 1998). This occurs in all amniotes, including humans (Dunsirn et al, 2016).…”

Types of improper child carrying

“…2 Flexion positions of the spine cause an increase in intra-spinal pressure, which results in disturbed blood flow and perfusion leading to disorders of oxidative metabolism in mitochondria of spinal neurons, 12 thus affecting axonal transport and nerve conduction disorders. 16 Hypovascular vertebral circulation disorders can cause vertebral growth disorders, which correlates with structural scoliosis. 13 Disorders in the curvature of the spine in the sagittal plane trigger the occurrence of deformations in the other planes of the spine, contributing to the development of posture defects in younger and younger children.…”