ELEVATED LEVELS OF TRANSFORMING-GROWTH-FACTOR-BETA-2 AND TRANSFORMING-GROWTH-FACTOR-BETA-3 IN LAMBDOID SUTURES FROM CHILDREN WITH PERSISTENT PLAGIOCEPHALY

Objective: To analyze the pertinent history and physical findings spec ific to the subset of patients with a progressive posterior skull defo rmity, requiring surgery to correct their deformity. Patients: Since t he Academy of Pediatrics issued its recommendation on supine positioni ng of infants to prevent sudden infant death syndrome (SIDS) in 1992, 73 children have presented to the University of Virginia Craniofacial Anomalies Clinic with posterior-skull deformities. The majority were s uccessfully managed with conservative therapy, but in six patients, th e deformity was severe and persistent, requiring surgical correction. All six children were older (7.5-12 mo), presenting with more severe m orphologic appearances and a higher incidence of associated neurodevel opmental delay. Three had family backgrounds of isolated craniosynosto sis. Methods: Characteristics of these patients were examined to deter mine why they may have differed from those that responded to conservat ive management. Immunohistochemical staining of their lambdoid sutures was performed. Results: Significantly increased staining for TGF-beta (2) and TGF-beta(3), potent stimulators of bone cell growth and differ entiation, was seen in all 'affected' sutures from the flattened side of the skull, compared to unaffected sutures from the protruding side of the skull-a pattern similar to that seen during normal bony obliter ation of calvarial sutures. Conclusion: The majority of patients with posterior plagiocephaly associated with positioning responded to conse rvative management, while a small subset of patients with persistent p osterior skull deformation required surgical intervention. A genetic b asis for the latter patients' persistent plagiocephaly, rather than po sitioning, cannot be ruled out. Genetics, prolonged external pressure against the sutures, or a combination of these factors may lead to per manently raised levels of growth factors in 'affected' sutures.