t’s Monday morning and you enter the NICU ready to begin seeing patients. The neonatologist sees you and says, “I’m putting in a therapy order for the baby in room 5; his head is really flat!”
Since the implementation of the Back to Sleep campaign by the American Academy of Pediatrics, there has been increased attention paid to head shape in babies. NICU professionals recognize the increased risk for head shape deformities in preterm infants due to pressure on the soft cranial bones when laying in a crib or isolette, decreased tone, and medical conditions/equipment that may necessitate the head being positioned in a specific way for extended periods of time. Neonatal therapists are uniquely qualified to provide recommendations for positioning and handling and implement additional therapeutic interventions to prevent or treat dolicocephaly and plagiocephaly in the preterm infant population. However, finding methods to determine severity of head shape deformity and monitor progress and change in an objective way remains a challenge.
A recent study published in Early Human Development sought to identify a reliable method for measuring head shape in preterm infants. This pilot study enrolled 68 preterm infants born below 34 weeks gestation. Researchers took measurements weekly with a pre-marked elastic headband for reference points and used a Ballert cranial caliper to measure head length, head width, and oblique distances. Cranial index to determine the presence of brachycephaly and dolicocephaly, and cranial vault asymmetry index to determine presence of plagiocephaly could then be calculated.
Measuring with the elastic headband and Ballert cranial calipers demonstrated moderate to good inter-rater retest reliability. This method is safe and feasible and takes only one to two minutes to perform. Additionally, the study reports that the prevalence of dolicocephaly was 82%, and the prevalence of plagiocephaly was 36% at time of NICU discharge in this sample.
Objective and reliable tools of measurement that can detect even small changes in head shape are important for neonatal therapy practice. Head shape deformities are associated with increased risk for developmental delay throughout early childhood. The above method of assessment can potentially facilitate more accurate and earlier identification of head shape deformities so that appropriate intervention can be provided as soon as possible. Additionally, having a more accurate way to evaluate head shape in conjunction with clinical observations could allow for better ways to determine if the therapeutic interventions being provided are creating change. Objective goal writing for documentation can also be improved using weekly measurements. Improved methods of evaluation of head shape in preterm infants can ultimately lead to better developmental outcomes for this vulnerable population.
Willis, S., Hsiao, R., Holland, R., Lee, K., & Pitetti, K. (2019). Measuring for nonsynostotic head deformities in preterm infants during NICU management: A pilot study. Early Human Development, 131, 56-62.
Abstract and link to full text article available at: https://www.sciencedirect.com/