目的 检索、评价并整合国内外有关婴儿期形态性头颅畸形(PP)预防及管理的最佳证据,为临床实践提供科学依据。方法 系统检索相关循证数据库和专业协会网站中所有关于婴儿期PP预防及管理的证据,检索时限截至2024年8月。由4名接受过循证医学培训的研究人员完成方法学质量评估、证据提取与整合工作。结果 共纳入文献16篇,包括2篇临床决策、3篇指南、2篇证据总结、7篇系统评价和2篇专家共识。共提取并整合30条最佳证据,涵盖9个方面:管理团队(1条)、风险因素识别(1条)、评估与诊断(7条)、枕头使用(1条)、体位管理(8条)、物理干预(5条)、头盔矫正(2条)、手术干预(2条)、健康教育与随访(3条)。现有证据提示,早期识别高危因素、规范评估、加强体位管理和俯卧活动,必要时联合物理治疗或头盔治疗,并重视家庭参与和随访管理,可能有助于婴儿期PP的预防和干预。结论 本研究总结了目前关于婴儿期PP预防及管理的最佳证据,为临床应用提供循证依据。但证据转化时,医护人员应根据实际情况及临床情境对婴儿进行个性化管理,不断优化婴儿期PP的预防与管理工作,以保障婴儿健康成长。
Abstract
Objective To retrieve, appraise, and synthesize the best available evidence on the prevention and management of positional plagiocephaly (PP) in infancy, so as to provide evidence-based references for clinical practice. Methods Evidence related to the prevention and management of PP in infancy was systematically searched in domestic and international evidence-based databases and relevant professional association websites, with the search conducted up to August 2024. Four trained researchers performed methodological quality appraisal, evidence extraction, and evidence synthesis. Results A total of 16 publications were included, comprising 2 clinical decision support resources, 3 guidelines, 2 evidence summaries, 7 systematic reviews, and 2 expert consensus statements. Thirty items of best evidence were extracted and summarized into 9 domains: multidisciplinary team (1 item), risk factor identification (1 item), assessment and diagnosis (7 item), pillow usage (1 items), positioning management (8 items), physical intervention (5 items), helmet therapy (2 items), surgical intervention (2 items), health education and follow-up(3 items). Current evidence suggests that early identification of risk factors, standardized assessment, appropriate positioning management and tummy time, combined physical therapy or helmet therapy when indicated, and strengthened family participation and follow-up may help prevent and manage PP in infancy. Conclusions This study summarizes the current best evidence on the prevention and management of PP in infancy and may provide a reference for clinical practice. When translating evidence into practice, healthcare professionals should implement individualized management according to infant characteristics, available medical resources, and specific clinical contexts to further optimize prevention and intervention outcomes.
关键词
婴儿 /
头颅畸形 /
预防 /
管理 /
证据总结
Key words
infants /
positional plagiocephaly /
prevention /
management /
evidence summary
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参考文献
[1] Watson AL, Winters R. Nonsyndromic craniofacial disorders[J]. Facial Plast Surg Clin North Am, 2024,32(1):127-139.
[2] 马伦昆,张智勇. 颅缝早闭症颅底结构的研究进展[J].中国美容整形外科杂志, 2023, 34 (6): 374-377.
[3] Blanco-diaz M, Marcos-alvarez M, Escobio-prieto I, et al. Effectiveness of conservative treatments in positional plagiocephaly in infants: A systematic review[J]. Children (Basel), 2023,10(7):1184.
[4] 张蕾,胡耀芳,葛俞伽,等.头颅畸形婴幼儿头颅形态特征及影响因素分析[J].中国儿童保健杂志,2023,31(2):200-204.
Zhang L,Hu YF, Ge YJ, et al. Cranial morphological characteristics and influencing factors of plagiocephaly in infants[J].Chin J Child Health Care,2023,31(2):200-204.(in Chinese)
[5] Lamberta LK, Murray TR, Gehred A, et al. Helmet therapy for positional plagiocephaly: A systematic review of the tools used to diagnose, offer treatment recommendations, and assess treatment outcomes of the condition[J]. Pediatr Neurol,2024,161:125-131.
[6] Charalambous L,Hadders-Algra M,N Yamasaki E, et al. Comorbidities of deformational plagiocephaly in infancy: A scoping review protocol[J].BMJ Paediatr Open,2021,5(1): e001113.
[7] Pinyot J, Lacambra D, Garriga M, et al. Positional plagiocephaly side and neurodevelopmental delay: Study on 408 infants[J].J Craniofac Surg,2024,35(7):2027-2035.
[8] Anderson PJ, Burnett A. Assessing developmental delay in early childhood: Concerns with the Bayley-III Scales[J]. Clin Neuropsychol, 2017, 31(2): 371-381.
[9] Flannery AM, Tamber MS, Mazzola C, et al. Congress of neurological surgeons systematic review and evidence-based guidelines for the management of patients with positional plagiocephaly: Executive summary[J].Neurosurgery, 2016,79(5): 623-624.
[10] 吴琼,王晓彤,黄艺文,等.婴儿俯卧活动指南[J].中国儿童保健杂志,2024, 32(8):813-820.
Wu Q, Wang XT, Huang YW, et al. Infancy tummy time guideline[J]. Chin J Child Health Care, 2024, 32 (8): 813-820.(in Chinese)
[11] Lin RS, Stevens PM, Wininger M,et al. Orthotic management of deformational plagiocephaly: Consensus clinical standards of care[J].Cleft Palate Craniofac J,2016,53(4):394-403.
[12] Liu G, Xiao L, Zhou X, et al. Summary of the best evidence for the safe use of pneumatic tourniquet in limb surgery[J].BMC Surg,2024,24(1):281.
[13] 邢唯杰,周英凤,朱政,等.证据金字塔的发展:从“6S”模型到“5S”模型[J].护士进修杂志,2025,40(13):1345-1348.
Xing WJ, Zhou YF, Zhu Z, et al. Evolution of the evidence pyramid: From the "6S" model to the "5S" model[J].Journal of Nurses Training,2025,40(13):1345-1348.(in Chinese)
[14] The Agree Next Steps Consortium.AGREE Ⅱ-users manualand 23-item instrument[EB/OL].(2017-10-15)[2021-02-15]. https://www.agreetrust.org/about-the-agree-enterprise/introduction-to-agree-ii/.
[15] 胡雁,周英凤.循证护理:证据临床转化理论与实践[M].上海:复旦大学出版社,2021:10.
Hu Y, Zhou YF. Evidence clinical implementation: Theory and practice[M]. Shanghai: Fudan University Press, 2021:10.(in Chinese)
[16] Foster MJ,Shurtz S. Making the critical appraisal for summaries of evidence(CASE)for evidence-based medicine(EBM):Critical appraisal of summaries of evidence[J].J Med Libr Assoc, 2013,101(3):192-198.
[17] 姜艳鑫,韩金燕,赵娟.1型糖尿病儿童/青少年低血糖预防策略的最佳证据总结[J].中国儿童保健杂志,2024,32(2):181-186.
Jiang YX, Han JY, Zhao J.Summary of best evidence hypoglycemia prevention strategies in children/teenagers with type 1 diabetes[J]. Chin J Child Health Care, 2019,32(2):181-186.(in Chinese)
[18] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11): 964-967.
[19] Edward PB.Overview of craniosynostosis[EB/OL].(2024-05-20) [2024-08-31]. https://www.uptodate.cn/contents/Overview of craniosynostosis-UpToDate.
[20] Charles GM.Congenital muscular torticollis:Management and prognosis[EB/OL].(2024-03-08) [2024-08-31].https://www.uptodate.cn/contents/Congenital muscular torticollis:Management and prognosis Topic Graphics-UpToDate.
[21] Moon RY,Carlin RF,Hand I,et al.Sleep-related infant deaths:Update 2022 recommendations for reducing infant deaths in the sleep environment[J].Pediatrics,2022,150(1):e2022057990.
[22] Flannery AM, Tamber MS, Mazzola C, et al. Congress of neurological surgeons systematic review and evidence-based guidelines for the management of patients with positional plagiocephaly: Executive summary[J]. Neurosurgery, 2016, 79(5): 623-624.
[23] Looman WS, Flannery AB. Evidence-based care of the child with deformational plagiocephaly, Part Ⅰ: Assessment and diagnosis[J].J Pediatr Health Care,2012,26(4): 242-253.
[24] Flannery AB, Looman WS, Kemper K. Evidence-based care of the child with deformational plagiocephaly, part Ⅱ: Management[J]. J Pediatr Health Care, 2012,26(5):320-331.
[25] Yang L, Fu H, Zhang L. A systematic review of improved positions and supporting devices for premature infants in the NICU[J]. Heliyon,2023,9(3):e14388.
[26] Watt A, Zammit D, Lee J,et al.Novel screening and monitoring technique for deformational plagiocephaly: A systematic review[J].Pediatrics,2022,149(2): e2021051736.
[27] Cabrera-Martos I, Ortigosa-Gómez SJ, López-López L, et al. Physical therapist interventions for infants with nonsynostotic positional head deformities: A systematic review[J]. Phys Ther,2021,101(8):pzab106.
[28] Hewitt L, Kerr E, Stanley RM, et al. Tummy time and infant health outcomes: A systematic review[J].Pediatrics,2020,145(6):e20192168.
[29] Ellwood J, Draper-RodI J, Carnes D. The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis:A synthesis of systematic reviews and guidance[J]. Chiropr Man Therap,2020,28(1):31.
[30] De Bock F, Braun V, Renz-Polster H. Deformational plagiocephaly in normal infants:A systematic review of causes and hypotheses[J].Arch Dis Child,2017,102(6):535-542.
[31] Lin RS, Stevens PM, Wininger M,et al. Orthotic management of deformational plagiocephaly: Consensus clinical standards of care[J].Cleft Palate Craniofac J,2016,53(4):394-403.
[32] Lennartsson F.Developing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: Searching for the evidence[J]. J Pediatr Nurs, 2011,26(4):348-358.
[33] Kuang AA, Bergquist C, Crupi L, et al. Effectiveness and safety of independent pediatric nurse practitioners in evaluating plagiocephaly[J].Plast Reconstr Surg,2013,132(2):414-418.
[34] O'Sullivan H, Bracken S, Doyle J, et al. X-rays had little value in diagnosing children's abnormal skull shapes, and primary care clinicians should refer concerns to specialist teams[J]. Acta Paediatr, 2021,110(4):1330-1334.
[35] Uchio Y, Shima N, Nakamura K,et al. Effects of continued positioning pillow use until a corrected age of six months on cranial deformation and neurodevelopment in preterm infants: A prospective case-control study[J]. Early Hum Dev, 2020,148:105137.
[36] Pastor-Pons I, Lucha-López MO, Barrau-Lalmolda M, et al. Efficacy of pediatric integrative manual therapy in positional plagiocephaly: A randomized controlled trial[J].Ital J Pediatr,2021,47(1):132.
[37] Chekmeyan M, Joo A, Saini S, et al. Parental education for the prevention of plagiocephaly[J]. Ann Plast Surg,2024,92(4 Suppl 2):204-206.
基金
江苏省医学会儿科医学科研专项资金项目[SYH-32034-0101(2024005)]
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