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Peer-reviewedCC BY 4.0Frontiers in Public Health

Positional cranial deformation and domain-specific neurodevelopment in small-for-gestational-age infants: a cross-sectional study

  • Jiang Zhu1
  • Dan Wu1,2
  • Lingyan Chen3
  • Daqian Zhu1
  • Yangyi Chen1
  • Masaya Tachibana3,4,5
  • Xia Hong1
  • Yoshiyuki Hirano6,7,8
  • Jinjin Chen1,9,10
10 affiliations
  1. 1Child Health Care Medical Division, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University
  2. 2Department of Cognitive Neuroscience, Donders Center for Brain, Cognition and Behaviour, Radboud University Medical Center
  3. 3Department of Child Development, United Graduate School of Child Development, The University of Osaka
  4. 4Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, The University of Osaka
  5. 5Department of Pediatrics, The University of Osaka Graduate School of Medicine
  6. 6Research Center for Child Mental Development, Chiba University
  7. 7United Graduate School of Child Development, The University of Osaka, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui
  8. 8Center for Cognitive Behavioral Therapy, Chiba University Hospital
  9. 9NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering
  10. 10College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine
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Abstract

Background: Infants born small for gestational age (SGA) face a higher likelihood of divergent neurodevelopmental trajectories. Positional cranial deformation is an early and observable clinical feature that has been associated with developmental differences in general populations, but its neurodevelopmental relevance in SGA infants remains unclear. This study investigated the associations between positional cranial deformation and domain-specific neurodevelopmental performance among SGA infants.

Methods: This cross-sectional analysis was conducted within a clinical follow-up cohort of SGA infants. A total of 156 infants who completed both three-dimensional cranial morphology assessment and Gesell Developmental Schedules (GDS) evaluation were included; the upper eligibility limit was 18 months of age. Assessments were concentrated in early infancy, with median ages of 6.36 months (IQR, 4.80–9.18) at cranial scanning and 6.90 months (IQR, 6.12–10.08) at GDS assessment. Multiple linear regression models examined the associations between cranial shape and developmental quotient (DQ) scores.

Results: Overall cranial deformation was associated with lower developmental quotient scores in the fine motor and adaptive behavior domains after false discovery rate correction ( P FDR < 0.05). Exploratory subtype analyses suggested similar patterns for brachycephaly and plagiocephaly, particularly in fine motor and adaptive behavior domains. The direction and magnitude of associations were generally consistent in sensitivity analyses.

Conclusion: Cranial deformation in SGA infants was associated with differences in developmental performance in fine motor and adaptive behavior domains. Exploratory subtype analyses suggested nominal associations for brachycephaly and plagiocephaly, but these associations were no longer significant after multiple-comparison correction. These findings suggest that cranial morphology may provide an accessible clinical indicator for developmental monitoring during SGA follow-up.

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Cite

BibTeXRIS
BibTeX
@article{zhu2026positional,
  title = {{Positional cranial deformation and domain-specific neurodevelopment in small-for-gestational-age infants: a cross-sectional study}},
  author = {Jiang Zhu and Dan Wu and Lingyan Chen and Daqian Zhu and Yangyi Chen and Masaya Tachibana and Xia Hong and Yoshiyuki Hirano and Jinjin Chen},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1936897},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1936897/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Positional cranial deformation and domain-specific neurodevelopment in small-for-gestational-age infants: a cross-sectional study
AU  - Jiang Zhu
AU  - Dan Wu
AU  - Lingyan Chen
AU  - Daqian Zhu
AU  - Yangyi Chen
AU  - Masaya Tachibana
AU  - Xia Hong
AU  - Yoshiyuki Hirano
AU  - Jinjin Chen
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1936897
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1936897/full
AB  - Background: Infants born small for gestational age (SGA) face a higher likelihood of divergent neurodevelopmental trajectories. Positional cranial deformation is an early and observable clinical feature that has been associated with developmental differences in general populations, but its neurodevelopmental relevance in SGA infants remains unclear. This study investigated the associations between positional cranial deformation and domain-specific neurodevelopmental performance among SGA infants.  Methods: This cross-sectional analysis was conducted within a clinical follow-up cohort of SGA infants. A total of 156 infants who completed both three-dimensional cranial morphology assessment and Gesell Developmental Schedules (GDS) evaluation were included; the upper eligibility limit was 18 months of age. Assessments were concentrated in early infancy, with median ages of 6.36 months (IQR, 4.80–9.18) at cranial scanning and 6.90 months (IQR, 6.12–10.08) at GDS assessment. Multiple linear regression models examined the associations between cranial shape and developmental quotient (DQ) scores.  Results: Overall cranial deformation was associated with lower developmental quotient scores in the fine motor and adaptive behavior domains after false discovery rate correction ( P FDR < 0.05). Exploratory subtype analyses suggested similar patterns for brachycephaly and plagiocephaly, particularly in fine motor and adaptive behavior domains. The direction and magnitude of associations were generally consistent in sensitivity analyses.  Conclusion: Cranial deformation in SGA infants was associated with differences in developmental performance in fine motor and adaptive behavior domains. Exploratory subtype analyses suggested nominal associations for brachycephaly and plagiocephaly, but these associations were no longer significant after multiple-comparison correction. These findings suggest that cranial morphology may provide an accessible clinical indicator for developmental monitoring during SGA follow-up.
SN  - 2296-2565
ER  -