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Published on: November 20, 2015
Prevalence and predictors of idiopathic asymmetry in infants born preterm
Jacqueline Nuysink1, Ingrid C van Haastert, Maria J C Eijsermans
1Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. j.nuysink@umcutrecht.nl
Insights
Idiopathic head asymmetry is common in preterm infants, increasing deformational plagiocephaly risk, especially in boys and twins. Early intervention is key, but avoid over-treatment as plagiocephaly prevalence decreases by 6 months corrected age.
Area of Science:
- Neonatal development
- Pediatric neurology
- Developmental pediatrics
Background:
- Idiopathic asymmetry (IA) of head posture is a known risk factor for developing deformational plagiocephaly (DP).
- IA is frequently observed in preterm infants at term-equivalent age (TEA).
Purpose of the Study:
- To determine the prevalence of IA in preterm infants at TEA and 6 months corrected age (CA).
- To identify demographic, perinatal, and medical predictors of IA.
- To compare motor maturation in infants with and without IA.
Main Methods:
- Retrospective analysis of 192 preterm infants (gestational age ≤32.0 weeks).
- Data abstracted included IA and DP frequencies, predictor variables, and Alberta Infant Motor Scale scores at 6 months CA.
- Statistical analyses included Chi-squared, Mann-Whitney, logistic regression, and t-tests.
Main Results:
- Prevalence of positional head preference at TEA was 44.8%; DP prevalence was 10.4% at TEA and 13% at 6 months CA.
- Positional preference, multiple birth, and male gender predicted DP (p<.05).
- Infants with positional preference at TEA showed less developed gross motor skills at 6 months CA compared to preterm norms (p=0.01).
Conclusions:
- High prevalence of positional preference in preterm infants at TEA necessitates vigilance to prevent DP, particularly in male infants and twins.
- Therapists should be mindful of potential over-treatment, as DP prevalence decreases by 6 months CA.
Background:
An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA).
Aims:
To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤32.0 weeks) at TEA and 6 months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry.
Methods:
In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6 months CA were abstracted and analyzed with Chi(2), Mann-Whitney, logistic regression and T-test.
Results:
The prevalence rate of a positional preference of the head at TEA was 44.8% (n=86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6 months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p<.05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6 months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p=0.01).
Conclusions:
The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6 months CA, therapists should be aware of over treating these infants.
