Impact of the Use of the Beanie on the Neurodevelopmental Outcomes of Preterm Infants With Plagiocephaly: A Pilot Study

Background Deformational plagiocephaly (DP) is the abnormal flattening of the skull. Infants with DP have been found to have abnormal brain shape and asymmetry associated with worse neurodevelopmental outcomes on the Bayley Scales of Infant and Toddler Development-III (BSID-III) compared to those without DP. In 2009, the FDA approved a repositioning Beanie, the TortleTM (Tortle Products LLC, Greenwood Village, CO), for the prevention of flat head syndrome. Purpose Our goal was to assess the impact of the use of the Beanie on the neurodevelopment of preterm infants with DP admitted in the neonatal intensive care unit (NICU) using the BSID-III. Methods Subjects were identified using a retrospective chart review of infants during January 2013-2017. Infants of less than 32 weeks of gestational age, under 1500 g birth weight, and attending the high-risk follow-up clinic were included in the study. Neurodevelopmental assessment of patients' cognition, language, motor development using the BSID-III was performed at the 12-month and 24-month follow-up visits. The BSID-III scores for patients who used the Beanie were compared to those who did not. Results A total of 207 patients met the inclusion criteria. The gestational age ranged from 22.5 to 31.5 weeks with a median and mean gestational age of 26.4 weeks and 26.5 weeks respectively. Of the patients, 105 were females and 102 males. The birth weight ranged between 460 g and 1460 g with a mean of 879 g and a median of 860 g. The Beanie was used in 32 patients; 31 patients were found to use the Beanie at 12 months and 16 patients at 24 months. Of note, 12-month Bayley cognition scores were found to be statistically improved in babies who used the Beanie versus those who did not (p: 0.02). The statistical significance was not appreciated at 24 months, which could be due to a decrease in the sample size. Conclusion The Beanie is an inexpensive and simple way to help prevent DP in preterm infants, which in turn could improve the aforementioned outcomes.