婴儿期形态性头颅畸形预防及管理的最佳证据总结

Best evidence summary of prevention and management of positional plagiocephaly in infancy

摘要

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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基金资助

江苏省医学会儿科医学科研专项资金项目[SYH-32034-0101(2024005)]