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Sep 18, 2024;13 e55695.

Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis.

Christopher Robert Timothy Hillyar, Natalie Bishop, Anjan Nibber, Frances Jean Bell-Davies, Juling Ong
Author Information
  1. Christopher Robert Timothy Hillyar: Oxford Medical School, Green Templeton College, University of Oxford, Oxford, United Kingdom. ORCID
  2. Natalie Bishop: UCL Medical School, University College London, London, United Kingdom. ORCID
  3. Anjan Nibber: Oxford Medical School, Green Templeton College, University of Oxford, Oxford, United Kingdom. ORCID
  4. Frances Jean Bell-Davies: Department of Paediatrics, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, United Kingdom. ORCID
  5. Juling Ong: Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. ORCID
PMID: 39292504 DOI: 10.2196/55695

Abstract

BACKGROUND: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry.
OBJECTIVE: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP.
METHODS: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots.
RESULTS: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected.
CONCLUSIONS: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed.
TRIAL REGISTRATION: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979.

Keywords

babies baby back to sleep bottle feeding child children deformational plagiocephaly flat head syndrome formula feeding head circumference head position head position preference head positioning infancy infant infants macrocephaly male sex maternal education level mechanical ventilation meta-analyses meta-analysis motor milestones neonatal neonate neonates obesity paediatric paediatrics pediatric pediatrics plagiocephaly sleeping position systematic review systematic reviews toddler toddlers tummy time vit D vitamin D

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