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Head Circumference is Relatively Larger than Size in Infants with Sagittal Craniosynostosis

Demetrius M. Coombs, MD; Nicholas R. Sinclair, MD; Niyant Patel, MD
Akron Children's Hospital & Cleveland Clinic

Presenter: Demetrius M. Coombs, MD


Director Name: Steven L. Bernard, MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Background & Purpose:
Sagittal craniosynostosis is the most common form of craniosynostosis. Efficacy of minimally invasive techniques decreases with age; thus, timely referral is critical. We sought to identify a screening tool using data from well-child visits to detect sagittal craniosynostosis in infants without macrocephaly. We hypothesized that many infants with sagittal craniosynostosis, but no macrocephaly based on growth chart plotting, in fact have a relative macrocephaly.

All infants with CT and surgically/pathologically confirmed isolated sagittal craniosynostosis that underwent surgery at our institution were identified. The following growth chart data was collected: head circumference (HC), weight, crown-to-toe-length, and World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) percentiles and deviation (z-scores). Absolute macrocephaly was defined as HC > 2 standard deviations (z-score > 2) from normal. Relative macrocephaly was defined as head circumference > 2 standard deviations from size (weight/length).

Thirty patients met inclusion criteria. WHO z-scores for HC versus weight (mean difference 1.98, 95% CI 1.62-2.34, p<0.0001) and length (mean difference 1.85, 95% CI 1.38-2.32, p<0.0001) at 2-4 months, were almost 2 deviations apart. CDC z-scores for head circumference versus weight and length differed by a mean of 1.04 and 1.02, respectively, (95% CIs 0.73-1.35 & 0.62-1.42, p<0.0001). Thirteen (44%) infants had absolute macrocephaly. Nine (53%) infants without absolute macrocephaly demonstrated relative macrocephaly.

Conclusions :
This preliminary study suggests that WHO growth data from routine well-child examinations could be used to develop a screening tool for sagittal craniosynostosis based upon relative and absolute macrocephaly.

Author Contact Information:
Demetrius Coombs
9500 Euclid Avenue
Desk A60
Cleveland, Ohio

8016710112 (cell)

Ohio,Pennsylvania,West Virginia,Indiana,Kentucky,Pennsylvania American Society of Plastic Surgeons

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