Early craniometric and neurological assessment of preterm infants: an observational study

Abstract

Introduction: Preterm infants show greater susceptibility to positional cranial asymmetry, which was long considered an aesthetic issue but has recently been associated with delayed neurodevelopment. Objective: To assess the prevalence of positional cranial asymmetries and compare the neurological assessment of preterm infants with and without cranial asymmetry at discharge from a neonatal intensive care unit (NICU). Methods: This observational study evaluated neonates who were born from 28 to 36 weeks and six days of gestational age at their NICU discharge and at 40 weeks of corrected gestational age. Cranial symmetry was measured by a craniometer. The cranial and cranial vault asymmetry indices were used to classify deformities. Neurological assessment was performed by the Hammersmith Neonatal Neurological Examination. Results: Overall, 50 neonates were evaluated at hospital discharge, of whom 64% (n = 32) showed cranial asymmetry, with isolated dolichocephaly occurring the most prevalently (66%, n = 21). This study evaluated 21 neonates at term-equivalent age, 71% (n = 15) of whom showed cranial asymmetry, with only plagiocephaly and plagiocephaly with dolichocephaly occurring most often, (40%; n = 6). The groups with and without asymmetry failed to significantly differ in neurological assessment scores, 33 [IQR 31–34] vs. 33 [IQR 32–34] totals, respectively (p = 0.885). Conclusion: Preterm infants showed a high prevalence of positional cranial asymmetry at discharge. Neurological assessment found no significant differences in early neurodevelopment between infants with and without cranial asymmetry, suggesting that this deformity may fail to impact early neurological outcomes.