TY  - JOUR
AU  - Hillyar, Christopher Robert Timothy
AU  - Bishop, Natalie
AU  - Nibber, Anjan
AU  - Bell-Davies, Frances Jean
AU  - Ong, Juling
PY  - 2024
DA  - 2024/9/18
TI  - Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis
JO  - Interact J Med Res
SP  - e55695
VL  - 13
KW  - deformational plagiocephaly
KW  - plagiocephaly
KW  - flat head syndrome
KW  - back to sleep
KW  - meta-analysis
KW  - systematic review
KW  - meta-analyses
KW  - systematic reviews
KW  - vitamin D
KW  - vit D
KW  - head position preference
KW  - head position
KW  - head positioning
KW  - bottle feeding
KW  - tummy time
KW  - sleeping position
KW  - motor milestones
KW  - obesity
KW  - maternal education level
KW  - male sex
KW  - formula feeding
KW  - macrocephaly
KW  - head circumference
KW  - mechanical ventilation
KW  - pediatric
KW  - pediatrics
KW  - paediatric
KW  - paediatrics
KW  - infant
KW  - infants
KW  - infancy
KW  - baby
KW  - babies
KW  - neonate
KW  - neonates
KW  - neonatal
KW  - toddler
KW  - toddlers
KW  - child
KW  - children
AB  - 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 
SN  - 1929-073X
UR  - https://www.i-jmr.org/2024/1/e55695
UR  - https://doi.org/10.2196/55695
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39292504
DO  - 10.2196/55695
ID  - info:doi/10.2196/55695
ER  -