Single-suture craniosynostosis poses risks

A large, multicenter study found that children with single-suture craniosynostosis (SSC) had consistently lower mean neurodevelopmental scores than did controls. The study was conducted in 209 children with SSC from 5 tertiary care craniofacial centers and 222 matched controls who were evaluated at baseline-before surgery in SSC patients and at a similar age in controls-and when aged 8 and 36 months.

Investigators used the Bayley Scales of Infant Development, which yields separate indices of infants' cognitive and psychomotor status (the Mental Development Index and the Psychomotor Development Index [PDI]), and the Preschool Language Scale, which yields 2 scale scores: receptive and expressive communication scales and a total language score. Standard scores are derived for all scales, with a normative average score of 100 (standard deviation, 15).

The median standardized neurodevelopmental scores for controls were about 100 or higher on all scales except the PDI, for which the median score was 95. The children with SSC, however, had lower mean scores than the controls on all scales. For 3 of the 4 outcome scales, 22% to 25% of patients with SSC scored in the delayed range compared with 10% to 13% of controls. In both groups, the greatest proportion of children was delayed on the PDI.

Commentary

The differences in developmental scores were not large but were common. The lessons I have taken from this study are to refer patients early when a child is diagnosed with even single-suture craniosynostosis and to be attentive to the developmental progress of these children both before and after surgery.
-Michael Burke, MD