Dr Gary F. Rogers

Comparison of a modifiable cranial cup versus repositioning and cervical stretching for the early correction of deformational posterior plagiocephaly

Authors

Rogers GF, Miller J, Mulliken JB

Published in

Plastic and Reconstructive Surgery 2008;121(3):941-947. DOI 10.1097/01.prs.0000299938.00229.3e (opens in a new tab)

Study design

Prospective, non-randomised trial

Participants

47 infants under 4 months with deformational posterior plagiocephaly: 24 on the cup, 23 controls managed with repositioning and neck stretching

Main finding

Mean transcranial difference fell from 11.2 mm to 3.5 mm in the cup group, against 9.0 mm to 8.0 mm with repositioning and stretching alone (p < 0.001). Mean time between first and final measurement was 56 days and 62 days.

Authors' conclusion

The modifiable concave resting surface was significantly more effective than repositioning and stretching alone for correcting early deformational plagiocephaly.

Limits

Not randomised. Controls were earlier patients managed with repositioning and stretching. The groups were similar at baseline for age, head rotation and initial asymmetry.

Correction of deformational plagiocephaly in early infancy using the Plagio Cradle orthotic

Authors

Seruya M, Oh AK, Sauerhammer TM, Taylor JH, Rogers GF

Published in

Journal of Craniofacial Surgery 2013;24(2):376-379. DOI 10.1097/SCS.0b013e31828010d1 (opens in a new tab)

Study design

Prospective study, stratified by start age

Participants

163 infants who started at 4 months or younger: 50 under 10 weeks, 113 at 10 to 20 weeks

Main finding

Transcranial difference improved by a mean 6.0 mm in infants who started before 10 weeks, and 4.0 mm in those who started at 10 to 20 weeks (P < 0.001). Mean treatment time was 6.9 and 5.7 weeks. Full correction, defined as 5 mm or less, was reached in 62.4% and 52.2% (P = 0.16).

Authors' conclusion

The Plagio Cradle can fully correct deformational plagiocephaly early in life, and treatment is more effective when started before 10 weeks of age.

Limits

No untreated control group. The younger group started with more asymmetry (11.0 mm against 9.0 mm).

Prevention of deformational plagiocephaly in hospitalized infants using a new orthotic device

Authors

DeGrazia M, Giambanco D, Hamn G, Ditzel A, Tucker L, Gauvreau K

Published in

Journal of Obstetric, Gynecologic & Neonatal Nursing 2015;44(1):28-41. DOI 10.1111/1552-6909.12523 (opens in a new tab)

Study design

Randomised, single-blinded, multisite

Participants

62 hospitalised infants with stays of 14 days or more: 35 on a moldable positioner, 27 rotating between the positioner and the cranial cup (target 12 hours a day). Both groups had routine position changes.

Setting

4 neonatal intensive care units

Main finding

At discharge, 46% (16 of 35) of infants on the positioner alone had abnormal cranial measurements, compared with 19% (5 of 27) in the cranial cup group (p = .03). Infants spent a median 10.7 hours a day on the cup. Emesis and cardiorespiratory events were evenly distributed between the two devices. Measurements were taken by orthotists blinded to group.

Authors' conclusion

Rotating the cranial cup with the moldable positioner is feasible, safe and potentially efficacious for preventing deformational plagiocephaly in hospitalised infants.

Limits

A prevention study in hospital with 62 infants. Head shape was measured at discharge, and the authors describe the effect as potentially efficacious.

Use of the cranial cup to correct positional head shape deformities in hospitalized premature infants

Authors

Knorr A, Gauvreau K, Porter CL, Serino E, DeGrazia M

Published in

Journal of Obstetric, Gynecologic & Neonatal Nursing 2016;45(4):542-552. DOI 10.1016/j.jogn.2016.03.141 (opens in a new tab)

Study design

Prospective descriptive study

Participants

23 premature infants (35 weeks or less at birth, over 1 kg) with visible deformational plagiocephaly

Setting

Level 4 NICU and Level 2 special care nursery

Main finding

At entry, 86% (19 of 23) had abnormal cranial measurements. At hospital discharge, 83% (19 of 23) had normal cranial measurements. Median use was 12.7 hours a day, and no safety concerns were reported.

Authors' conclusion

Using the cranial cup during the convalescent phase of hospitalisation is feasible and safe, and provides effective correction of deformational plagiocephaly for premature infants.

Limits

Single group with no control arm. Infants also had routine position changes every 3 to 4 hours.

Feasibility and safety of the Preemie Orthotic Device to manage deformational plagiocephaly in extremely low birth weight infants

Authors

Knorr A, Giambanco D, Staude MV, Germain M, Porter C, Serino E, Gauvreau K, DeGrazia M

Published in

Advances in Neonatal Care 2019;19(3):226-235. DOI 10.1097/ANC.0000000000000585 (opens in a new tab)

Study design

Phase 1 feasibility and safety pilot

Participants

10 extremely low birth weight infants under 1 kg (median 25.4 weeks gestation, median birth weight 673 g)

Setting

3 neonatal intensive care units

Main finding

The device was used a median 21.2 hours a day with no device-related adverse events. All 10 infants had normal cranial symmetry at enrolment and at completion. The number with a normal cranial index rose from 1 at enrolment to 5 at completion.

Authors' conclusion

The POD was feasible and safe, and staff responded favourably. Further studies are needed to assess its effectiveness.

Limits

A pilot of 10 infants, designed to test feasibility and safety rather than effectiveness.