Erica L. Waddington, Karen T. Snider, Michael D. Lockwood, Vanessa K. Pazdernik. Incidence of Somatic Dysfunction in Healthy Newborns. J Am Osteopath Assoc 2015;115(11):654–665. doi: 10.7556/jaoa.2015.136.
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Context: Recent evidence suggests that osteopathic manipulative treatment of somatic dysfunction in newborns may decrease complications and hospital length of stay. Such dysfunction may result from external forces related to the birth process, but its incidence is unknown.
Objective: To identify the incidence and patterns of somatic dysfunction in healthy newborns at least 6 hours after birth and to correlate those findings with maternal and labor history, gestational age, and findings of the initial newborn assessment performed immediately after birth.
Methods: Healthy newborns aged 6 to 72 hours were physically examined and assessed for somatic dysfunction, including asymmetry and motion restriction of the cranial, cervical, lumbar, and sacral regions. The total somatic dysfunction identified was summarized in a somatic dysfunction severity score (SDSS), calculated by assigning 1 point for each identified finding; the SDSS could range from 0 (no somatic dysfunction) to 34 (all somatic dysfunctions assessed present). Findings were correlated with maternal and newborn characteristics and labor history. Descriptive analyses were performed, and findings were compared between the initial newborn assessment and the research examination.
Results: One hundred newborns were examined (mean gestational age, 38.5 weeks). In 99 newborns (99%), at least 1 sphenobasilar synchondrosis strain pattern was present, with sidebending rotations being the most common (present in 63 newborns [63%]). Condylar compression was found in 95 newborns (95%), temporal bone restrictions in 85 (85%), motion restriction of at least 1 cervical vertebral segment in 91 (91%) and at least 1 lumbar vertebral segment in 94 (94%), and a posterior sacral base in 80 (80%). The SDSS was not associated with mode of delivery or labor augmentation (P=.49 and P=.54, respectively), but it was positively associated with the duration of labor; each 1-hour increase in labor increased the predicted SDSS by 0.12 points (P=.04).
Conclusion: Somatic dysfunction of the cranial, cervical, lumbar, and sacral regions was common in healthy newborns, and the total somatic dysfunction (SDSS) was related to the length of labor. (ClinicalTrials.gov number NCT01496872)
a Data represent No. (%) of mothers or deliveries, except where otherwise specified for maternal age.
b Individual deliveries may have involved more than 1 type of labor augmentation or anesthesia.
c Three newborns had 2 head presentations at delivery: 2 had compound, right occiput anterior, and 1 had compound, vertex.
a Agreement reported as concordance correlation coefficient (CCC),11,12 weighted κ, or simple κ, with corresponding P values.
Abbreviations: CRI, cranial rhythmic impulse; NA, not assessed during examination.
a Two strain patterns were identified in 11 newborns, and 3 in 1 newborn.
b Directionality of torsions, sidebending rotations, vertical strains, and lateral strains was not recorded for the first 44 newborns evaluated.
c Seventy-eight newborns had 2 or more cranial quadrant motion restrictions.
a The P value for the overall significance of the relationship to the somatic dysfunction severity score (SDSS) is included next to each characteristic. Continuous characteristics only have a regression coefficient estimate. Categorical characteristics with 2 levels include the mean SDSS at each level and the regression coefficient for the nonreference level. Categorical characteristics with more than 2 levels include the mean SDSS at each level, the regression coefficient for nonreference levels, and the P value for the significance between each nonreference level and the reference level. The reference level is the first one listed, except for “Labor Augmentation” and “Type of Anesthesia,” for which the reference level is “none.”
b SDSS for infants born via cesarean deliveries were compared with infants born via vaginal deliveries.
c Mothers may have accepted more than 1 type of labor augmentation and anesthesia.
d SDSS for infants born delivered with labor augmentation were compared with infants born without labor augmentation.
e SDSS for infants born delivered with maternal anesthesia were compared with infants born without maternal anesthesia.
f n=100. Includes both mothers who labored before delivery and those who did not labor before delivery, regardless of mode of delivery.
g n=75. Includes only mothers who were in labor before delivery, regardless of mode of delivery.
Abbreviation: CRI, cranial rhythmic impulse.
a Unilaterally, the sacral base could be either anterior or posterior, but not both.
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