Skull and aerodigestive tract growth in early postnatal life: establishing a sample
Authors: Curcio Daniella Franco , Delgado Jorge , Meaike Joshua T. , Gupta Anmol , Zur Karen , Shekdar Karuna , Laitman Jeffrey T. 
Published: November 2023

The first months of human post‐natal life are a crucial period for the development and integration of skull and aerodigestive tract (ADT) structures. Anatomical changes coincident with central and peripheral neural development are essential factors that contribute to the establishment of the infant's coordination of breathing and swallowing. This component of our ongoing research has been to identify an optimum MRI database to assess these changes in a joint collaboration between the Children's Hospital of Philadelphia (CHOP) and the Icahn School of Medicine at Mount Sinai (Institutional Review Board approvals: IRB# 16‐012716, HS#: 15‐00198 and GCO#1: 15‐0529/0001). In our prior studies (Curcio et al. 2014, Meaike et al. 2015, Gupta et al. 2015) we identified key features that may be essential to assess and chart the growth of skull and ADT structures, and to track resultant positional shifts. We initially reviewed a total of 806 medical files and MRI scans obtained between 2013 and 2015 at CHOP. To obtain a sample that was anatomically normal and absent of systemic pathologies possibly interfering with growth and proportions of skull and ADT structures, we conducted a two‐step triage process. First, we reviewed the medical files and applied the following exclusion criteria: infants born under 37 and over 42 weeks of gestational age; born with less than 2.5 and more than 4kg; diagnosed growth disorders; diagnosed syndromes (e.g.: Chiari, 1st and 2nd branchial arch syndromes); head circumference beyond normal limits. We then assessed the remaining images and applied the following exclusion criteria: presence of trauma or conditions that determine anatomic abnormalities in the integrity, size, growth and proportions of craniofacial bones and ADT structures; cleft lip, palate / facial cleft; craniosynostosis, microcephaly, hydrocephaly; brain and/or head and neck mass tumors causing deformities of skull and/or ADT structures. Study sample now comprises 157 infants, 81 females, 75 males, from 0 to 5.07 months of age (average=1.33 months, median=0.87 months), distributed per age group as follows: 0–1month (mo) n=84; 1.1–2mo n=36; 2.1–3mo n=15; 3.1–4mo n=5; 4.1–5mo n=16. Next steps will be to validate a protocol to measure skull and ADT structures in the mid‐sagittal (MS) and in axial planes (AP), with optimal reproducibility and accuracy. Our hypothesis is that craniofacial and ADT structures develop with regularity, allowing for predictability and determination of normal growth trajectories. Better understanding of functional morphologic relationships between skull and ADT in normal infants during this sensitive window of time may contribute to improving recognition, assessment, and treatment strategies/techniques for a number of conditions, including SIDS, cleft lip and palate, craniosynostosis, microcephaly, craniofacial syndromes among others.Support or Funding InformationGrant Funding Source: National Counsel of Technological Development – CNPq (Brazil)