Skip to main content
SpringerLink
Log in

Neurological assessment of Chinese infants with positional plagiocephaly using a Chinese version of the Infant Neurological International Battery (INFANIB)

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Positional plagiocephaly (PP) is the most common subtype of asymmetric deformity in the infant skull. Cumulative evidence has demonstrated that PP is associated with abnormal neuromotor development; however, neurological assessment scores of infants with PP have not been well established, and PP has not attracted sufficient attention in China. This study used a Chinese version of the Infant Neurological International Battery (INFANIB) to identify neurological abnormalities among infants with PP and to determine the differences between infants with different (mild, moderate, and severe) degrees of PP.

Methods

We compared the neurological evaluation scores between 393 infants with different degrees of PP and 390 healthy infants from 0 to 18 months of age using a Chinese version of the INFANIB.

Results

The infants with PP aged 0–7.9 months had lower scores on the spasticity, head and trunk, leg, and French angle subscales and lower total scores than the normal infants. Additionally, the infants with PP aged 9–18 months showed statistically significantly lower scores on the spasticity, head and trunk, vestibular function, leg, and French angle subscales and total scores than the normal infants. Among the PP subgroups, the infants with mild PP had the highest scores, followed by the infants with moderate PP and the infants with severe PP. Compared with the normal infants, the infants with PP had abnormal neurological assessment scores, and the degree of neurological abnormality was associated with the severity of PP.

Conclusions

The INFANIB revealed neurological abnormalities, including asymmetric movements and abnormal muscle tone, postures, and reflexes, in infants with PP, especially those with moderate or severe PP. These abnormalities were similar to those of infants with cerebral palsy. Therefore, PP may serve as a marker of neurodevelopmental risk and should receive considerable attention. Whether moderate or severe PP is related to cerebral palsy remains to be confirmed in long-term follow-up studies and other future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aldridge K, Marsh JL, Govier D, Richtsmeier JT (2002) Central nervous system phenotypes in craniosynostosis. J Anat 201:31–39

    Article  PubMed  PubMed Central  Google Scholar 

  2. American Academy of Pediatrics (1992) AAP Task Force on Infant Positioning and SIDS: positioning and SIDS. Pediatrics 89:1120–1126

    Google Scholar 

  3. Bialocerkowski AE, Vladusic SL, Wei Ng C (2008) Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol 50:577–586. doi:10.1111/j.1469-8749.2008.03029.x

    Article  PubMed  Google Scholar 

  4. Branch LG, Kesty K, Krebs E, Wright L, Leger S, David LR (2015) Deformational plagiocephaly and craniosynostosis: trends in diagnosis and treatment after the “back to sleep” campaign. The Journal of craniofacial surgery 26:147–150. doi:10.1097/SCS.0000000000001401

    Article  PubMed  Google Scholar 

  5. Cabrera-Martos I, Valenza MC, Valenza-Demet G, Benitez-Feliponi A, Robles-Vizcaino C, Ruiz-Extremera A (2015) Impact of torticollis associated with plagiocephaly on infants’ motor development. The Journal of craniofacial surgery 26:151–156. doi:10.1097/SCS.0000000000001402

    Article  PubMed  Google Scholar 

  6. Collett B, Breiger D, King D, Cunningham M, Speltz M (2005) Neurodevelopmental implications of “deformational” plagiocephaly. Journal of developmental and behavioral pediatrics: JDBP 26:379–389

    Article  PubMed  PubMed Central  Google Scholar 

  7. Collett BR, Aylward EH, Berg J, Davidoff C, Norden J, Cunningham ML, Speltz ML (2012) Brain volume and shape in infants with deformational plagiocephaly. Child’s nervous system: ChNS: official journal of the International Society for Pediatric Neurosurgery 28:1083–1090. doi:10.1007/s00381-012-1731-y

    Article  Google Scholar 

  8. Cummings C (2011) Positional plagiocephaly. Paediatrics& child health 16:493–496

    Article  Google Scholar 

  9. Ellison PH (1986) Scoring sheet for the Infant Neurological International Battery (INFANIB). Suggestion from the field Physical therapy 66:548–550

    Article  CAS  PubMed  Google Scholar 

  10. Fowler EA, Becker DB, Pilgram TK, Noetzel M, Epstein J, Kane AA (2008) Neurologic findings in infants with deformational plagiocephaly. J Child Neurol 23:742–747. doi:10.1177/0883073808314362

    Article  PubMed  Google Scholar 

  11. Hutchison BL, Hutchison LA, Thompson JM, Mitchell EA (2004) Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 114:970–980. doi:10.1542/peds.2003-0668-F

    Article  PubMed  Google Scholar 

  12. Jennings JT, Sarbaugh BG, Payne NS (2005) Conveying the message about optimal infant positions. Physical & occupational therapy in pediatrics 25:3–18

    Article  Google Scholar 

  13. Joganic JL, Lynch JM, Littlefield TR, Verrelli BC (2009) Risk factors associated with deformational plagiocephaly. Pediatrics 124:e1126–e1133. doi:10.1542/peds.2008-2969

    Article  PubMed  Google Scholar 

  14. Knight SJ, Anderson VA, Meara JG, Da Costa AC (2013) Early neurodevelopment in infants with deformational plagiocephaly. The Journal of craniofacial surgery 24:1225–1228. doi:10.1097/SCS.0b013e318299777e

    Article  PubMed  Google Scholar 

  15. Kordestani RK, Patel S, Bard DE, Gurwitch R, Panchal J (2006) Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg 117:207–218 discussion 219–220

    Article  CAS  PubMed  Google Scholar 

  16. Liao W, Wen EY, Li C, Chang Q, Lv KL, Yang W, He ZM, Zhao CM (2012) Predicting neurodevelopmental outcomes for at-risk infants: reliability and predictive validity using a Chinese version of the INFANIB at 3, 7 and 10 months. BMC Pediatr 12:72. doi:10.1186/1471-2431-12-72

    Article  PubMed  PubMed Central  Google Scholar 

  17. Looman WS, Flannery AB (2012) Evidence-based care of the child with deformational plagiocephaly, part I: assessment and diagnosis. Journal of pediatric health care: official publication of National Association of Pediatric Nurse Associates & Practitioners 26:242–250 . doi:10.1016/j.pedhc.2011.10.003quiz 251-243

    Article  Google Scholar 

  18. Majnemer A, Barr RG (2006) Association between sleep position and early motor development. J Pediatr 149:623–629. doi:10.1016/j.jpeds.2006.05.009

    Article  PubMed  Google Scholar 

  19. Miller RI, Clarren SK (2000) Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 105:E26

    Article  CAS  PubMed  Google Scholar 

  20. Nuysink J, Eijsermans MJ, van Haastert IC, Koopman-Esseboom C, Helders PJ, de Vries LS, van der Net J (2013) Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants. J Pediatr 163:658–665 . doi:10.1016/j.jpeds.2013.04.015e651

    Article  PubMed  Google Scholar 

  21. Pedersen SJ, Sommerfelt K, Markestad T (2000) Early motor development of premature infants with birthweight less than 2000 grams. Actapaediatrica 89:1456–1461

    CAS  Google Scholar 

  22. Pin T, Eldridge B, Galea MP (2007) A review of the effects of sleep position, play position, and equipment use on motor development in infants. Dev Med Child Neurol 49:858–867. doi:10.1111/j.1469-8749.2007.00858.x

    Article  PubMed  Google Scholar 

  23. Roby BB, Finkelstein M, Tibesar RJ, Sidman JD (2012) Prevalence of positional plagiocephaly in teens born after the “back to sleep” campaign. Otolaryngology—head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 146:823–828. doi:10.1177/0194599811434261

    Article  Google Scholar 

  24. Shweikeh F, Nuno M, Danielpour M, Krieger MD, Drazin D (2013) Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines. Neurosurg Focus 35:E1. doi:10.3171/2013.8.FOCUS13261

    Article  PubMed  Google Scholar 

  25. Soleimani F, Badv RS, Momayezi A, Biglarian A, Marzban A (2015) General movements as a predictive tool of the neurological outcome in term born infants with hypoxic ischemic encephalopathy. Early Hum Dev 91:479–482. doi:10.1016/j.earlhumdev.2015.05.007

    Article  PubMed  Google Scholar 

  26. Soleimani F, Dadkhah A (2007) Validity and reliability of Infant Neurological International Battery for detection of gross motor developmental delay in Iran. Child Care Health Dev 33:262–265. doi:10.1111/j.1365-2214.2006.00704.x

    Article  CAS  PubMed  Google Scholar 

  27. Speltz ML, Collett BR, Stott-Miller M, Starr JR, Heike C, Wolfram-Aduan AM, King D, Cunningham ML (2010) Case-control study of neurodevelopment in deformational plagiocephaly. Pediatrics 125:e537–e542. doi:10.1542/peds.2009-0052

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vu HL, Panchal J, Parker EE, Levine NS, Francel P (2001) The timing of physiologic closure of the metopic suture: a review of 159 patients using reconstructed 3D CT scans of the craniofacial region. The Journal of craniofacial surgery 12:527–532

    Article  CAS  PubMed  Google Scholar 

  29. Wilbrand JF, Wilbrand M, Pons-Kuehnemann J, Blecher JC, Christophis P, Howaldt HP, Schaaf H (2011) Value and reliability of anthropometric measurements of cranial deformity in early childhood. Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 39:24–29. doi:10.1016/j.jcms.2010.03.010

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr. Geoffrey Heintzelman for his proofreading and his suggestions regarding this manuscript. This work was supported by the Chongqing Integrated Demonstration Program (Huimin Project, No. CSTC2013JCSFC0007).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Xinqiao Hospital, Third Military Medical University, 2-V Xinqiao Street, Chongqing, 400037, China

    Xue-Qing Zhao, Li-Yan Wang, Cong-Min Zhao, Qing Men, Zhi-Feng Wu & Yu-Ping Zhang

Authors
  1. Xue-Qing Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Yan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cong-Min Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qing Men
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhi-Feng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu-Ping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu-Ping Zhang.

Ethics declarations

Participants were enrolled after a signed informed consent form was received from a parent or guardian; approval was obtained from the Human Research Ethics Committee of Xinqiao Hospital of Third Military Medical University.

Conflict of interest

The authors have no conflict of interest.

Additional information

Xue-Qing Zhao and Li-Yan Wang contributed equally to this report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, XQ., Wang, LY., Zhao, CM. et al. Neurological assessment of Chinese infants with positional plagiocephaly using a Chinese version of the Infant Neurological International Battery (INFANIB). Childs Nerv Syst 33, 281–288 (2017). https://doi.org/10.1007/s00381-016-3260-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-016-3260-6

Keywords

Search

Navigation