Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: what is the gain? A nationwide survey.

Zahl SM, Wester K. Pediatrics.2008; 121 (3).
OBJECTIVE. The aim of the present study was to investigate the importance of routine head circumference measurements in the detection of intracranial expansive conditions, because only fragmented evidence exists in favor of this routine.
METHODS. The study was a nationwide study based on the medical records of all Norwegian departments of pediatrics and neurosurgery. The study included all Norwegian children <5 years of age who were hospitalized because of intracranial expansion during a 4-year period (1999–2002). Information about diagnostic codes, symptoms, and ages at symptom onset and at admission was collected from the medical records.
RESULTS. The study included 298 patients. For 173 (58%), hydrocephalus was the primary diagnosis; 57 (19%) had intracranial tumors and 68 (23%) had other primary diagnoses. For 46% of the children, increased head circumference was the first and main symptom leading to diagnosis. Increased head circumference was much more common as the symptom that led to diagnosis for patients with hydrocephalus (72%), compared with patients with cysts (31%) or tumors (5%). Increasing head circumference seems important mainly in detecting hydrocephalus and cysts, especially during the first 10 months of life.
CONCLUSIONS. Routine measurements of head circumference during the first year of life mainly detect infants with hydrocephalus or cysts; other expansive conditions yield other symptoms. Most children with increased head circumference as a symptom of intracranial expansion are identified during the first 10 months of life.

What We Gain by Measuring Head Circumference
Robin K. Wilson and Michael A. Williams
Pediatrics 2008; 122: 219-220.

What We Gain by Measuring Head Circumference: In Reply
Sverre Morten Zahl and Knut Wester
Pediatrics 2008; 122: 220-221.