Christopher Robert Timothy Hillyar, Natalie Bishop, Anjan Nibber, Frances Jean Bell-Davies, Juling Ong
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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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? 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Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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). 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引用次数: 0
摘要
背景：头颅畸形（Plagiocephaly）是指头颅的不对称变形，导致头部呈斜梯形或平行四边形。变形性头颅畸形（DP）是由作用于一侧后脑勺的力造成的，扭曲了正常的头颅对称性：本系统综述和荟萃分析的目的是严格评估导致畸形头畸形的非产科风险因素的证据，并为降低畸形头畸形的患病率提出循证建议：方法：选择标准是报告 DP 风险因素的研究。排除了病例回顾、系列病例、专家意见和系统回顾。检索了 2010 年 8 月 21 日至 2022 年 8 月 21 日期间的 PubMed 和 Web of Science。采用漏斗图评估发表偏倚。采用森林图进行元分析：共纳入 19 项研究（队列研究：n=13，占 68%；病例对照研究：n=5，占 26%；横断面研究：n=1，占 5%），共有 14 808 名参与者。在 43 项被调查的潜在非产科因素中，16 项（37%）与 DP 相关。在这 16 个因素中，12 个因素（75%）的几率比（ORs）与 95% CIs 不超过 1：维生素 D 摄入不足（OR 7.15，95% CI 3.77-13.54）、头位偏好（OR 4.75，95% CI 3.36-6.73）、只用奶瓶喂养（OR 4.65，95% CI 2.70-8.00）、腹部时间减少（OR 3.51，95% CI 1.71-7.21）、睡姿（OR 3.12，95% CI 2.21-4.39）、运动里程数减少（OR 3.15，95% CI 3.77-13.54）。37）、男性（OR 1.51，95% CI 1.07-2.12）、配方喂养（OR 1.51，95% CI 1.00-2.27）、头围（OR 1.22，95% CI 1.06-1.40）和机械通气（OR 1.10，95% CI 1.00-1.14）。未发现发表偏倚的证据：本研究对与DP相关的非产科因素进行了全面评估，并提出了11项循证建议以降低其发生率。主要局限性在于仅评估了发表偏倚：PERCORCO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php?id=crd42020204979。
Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis.
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.
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