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Becker de Oliveira L, Fonseca-Souza G, Rolim TZC, Scariot R, Feltrin-Souza J. Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024; 61:1344-1355. [PMID: 37078146 DOI: 10.1177/10556656231170137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To evaluate the association between cleft lip and/or cleft palate (CL/P) and breastfeeding (BF). DESIGN A systematic review and meta-analysis were performed based on studies published in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, BBO, and Embase databases, and in the gray literature. The search occurred in September 2021 and was updated in March 2022. Observational studies evaluating the association between BF and CL/P were included. Risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted. Certainty of evidence was evaluated using the GRADE approach. MAIN OUTCOME MEASURE(S) Frequency of BF in relation to the presence or absence of CL/P, as well as to the type of CL/P. The association between cleft type and BF challenges was also evaluated. RESULTS From a total of 6863 studies identified, 29 were included in the qualitative review. Risk of bias was moderate and high in most studies (n = 26). There was a significant association between the presence of CL/P and absence of BF (OR = 18.08; 95% CI 7.09-46.09). Individuals with cleft palate with or without cleft lip (CP ± L) had a significantly lower frequency of BF (OR = 5.93; 95% CI 4.30-8.16) and a significantly higher frequency of BF challenges (OR = 13.55; 95% CI 4.91-37.43) compared to individuals with CL. Certainty of the evidence was low or very low in all analyses. CONCLUSION The presence of clefts, especially those with palate involvement, is associated with higher chances of absence of BF.
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Affiliation(s)
- Luiza Becker de Oliveira
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Gabriela Fonseca-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Tatiane Zahn Cardoso Rolim
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Rafaela Scariot
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
| | - Juliana Feltrin-Souza
- Department of Stomatology, Universidade Federal do Paraná, Setor de Ciências da Saúde, Av. Prefeito Lothário Meissner 632, Curitiba, State of Paraná 80210-170, Brazil
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Williams JL, Halvorson M, Kotlarek KJ. Lack of Immediate Diagnosis and Appropriate Intervention Leads to Malnutrition in an Infant With Cleft Palate. J Pediatr Health Care 2024:S0891-5245(24)00178-0. [PMID: 39046401 DOI: 10.1016/j.pedhc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/25/2024]
Abstract
This case report describes a full-term infant with a cleft palate who experienced malnutrition because of the delayed introduction of a cleft-adapted bottle and identifies potential areas for improvement in clinical practice. The infant's weight for age z-score at birth was 0.05 and dropped to -1.45 by 2 months of age, indicating mild malnutrition. The infant established care with a cleft team and a cleft-adapted bottle was recommended as the primary feeding method. Feeding time subsequently decreased from 60 minutes per feeding to 20 minutes. The infant presented for palate repair at 9 months of age, and his z-score was -0.01, indicating he was no longer malnourished. Cleft-adapted bottles aid in feeding efficiency in infants with cleft palate, which may subsequently impact weight gain. Appropriate weight gain is essential to receive timely cleft palate repair and support healing.
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Wagner CS, Barrero CE, Kumar SL, Pontell ME, Salinero LK, Bartlett SP, Taylor JA, Folsom N, Swanson JW. Characterizing Interventions and Family Assistance of a Nurse Navigation Program in Orofacial Cleft Care. Cleft Palate Craniofac J 2024; 61:1164-1171. [PMID: 36895093 DOI: 10.1177/10556656231163397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE Characterize the interventions and assistance employed by a cleft nurse navigator (CNN) which have mediated improvement in care equity at our institution. DESIGN Retrospective study. SETTING Academic tertiary care center. PATIENTS, PARTICIPANTS Patients presenting with cleft lip and/or cleft palate presenting between August 2020 and August 2021 with exclusions for syndromic diagnosis, Pierre-Robin sequence, late (> 6 months) presentation, and prior cleft surgery at outside institutions. INTERVENTIONS Multidisciplinary cleft nurse navigator program. MAIN OUTCOME MEASURE(S) Family interactions with the CNN by phone, text, and email across the first year of life including feeding support, nasoalveolar molding (NAM) assistance, appointment scheduling, financial assistance, addressing perioperative concerns, and facilitating physician consults. Patient weight and surgical timing were also recorded. RESULTS Sixty-nine patients were included with a total of 639 interactions between the CNN and families. Scheduling support (30%), addressing perioperative concerns (22%), and feeding support (20%) were the most common interactions. Feeding support and NAM assistance were heavily distributed in the first 3 months of life compared to after 3 months (P < .001). Median age at first contact was 1 week (range: 22 weeks gestation-14 weeks). There was no difference in the proportion of families receiving feeding support, NAM assistance, or scheduling assistance based on insurance status or race (P > .05 for all). CONCLUSIONS Scheduling assistance, addressing perioperative concerns, and feeding support are the predominant methods by which the CNN interacts with and assists families of patients with cleft conditions. CNN service distribution is largely equitable between demographic groups.
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Affiliation(s)
- Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Satvika L Kumar
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy Folsom
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abdilahi A, Ramin S, Meyer C, Chinnadurai S, Morrell N, Tibesar R, Roby B. The Effect of Palatoplasty on Growth. Laryngoscope 2024. [PMID: 38924106 DOI: 10.1002/lary.31593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To assess the effect of palatoplasty on growth velocity in undernourished and nourished orally fed children with cleft palate. METHODS A retrospective chart review was conducted using a data query with cleft-associated ICD-10 and ICD-9 codes to identify children who underwent cleft palate repair between 2006 and 2022 at a tertiary pediatric hospital. Data gathered included demographics, admission variables, weight gain, and weight percentile as per the WHO growth chart data. Inclusion was limited to patients with complete growth data and without parenteral feeding support. Nutritional status was defined as undernourished (≤3rd percentile) and nourished (>3rd percentile). Between and within-group comparisons were made using nonparametric tests. RESULTS A total of 192 patients met the study criteria. Among undernourished patients, the median pre- and postsurgical weekly weight gain was 0.09 kg and 0.05 kg (p = <0.0001), and the median growth percentiles were 0.67% and 1.1%, respectively (p = 0.03). Among nourished patients, the median pre- and postsurgical weekly weight gain was 0.12 kg and 0.07 kg (p = <0.0001), and the median growth percentiles were 25.4% and 29.5%, respectively (p = <0.0001). The postsurgical reduction in weight gain per week was similar across nutritional status (p = 0.43), however, the nourished group demonstrated a larger increase in median growth percentile (3.3% vs. 0.23%; p = 0.03). CONCLUSION This study demonstrates that palatoplasty does not independently improve growth velocity in children who were able to maintain an oral preoperative diet. In the case of undernourished children, there was no clinically significant improvement in postoperative growth percentiles. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Abdiasis Abdilahi
- University of Minnesota Medical School-Twin Cities, Minneapolis, Minnesota, U.S.A
| | - Seth Ramin
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, U.S.A
| | - Cassandra Meyer
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Sivakumar Chinnadurai
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology, Bahir Dar University College of Health Sciences, Bahir Dar, Ethiopia
| | - Noelle Morrell
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Robert Tibesar
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Brianne Roby
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Prezelski K, Villarreal Acha D, Ngo TVC, Wilson C, Thrasher V, Trevino K, Van't Slot C, Hallac RR, Seaward JR, Kane AA. A Dedicated Multidisciplinary Growth and Feeding Clinic for Infants with Cleft Lip and/or Palate Demonstrates Need for Intervention. Cleft Palate Craniofac J 2024:10556656241258687. [PMID: 38860332 DOI: 10.1177/10556656241258687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented. DESIGN This study assessed the effect of preoperative feeding interventions provided by the GFC. SETTING Tertiary academic center. METHODS This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than -2.00 was used as a cutoff to classify patients who were underweight during the preoperative period. MAIN OUTCOME MEASURE The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure. RESULTS Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits (P < .001) and GFC interventions (P < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients (P = .0187). CONCLUSION This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.
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Affiliation(s)
- Kayla Prezelski
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Daniel Villarreal Acha
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tuong-Vi Cindy Ngo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin Wilson
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Vania Thrasher
- Department of Clinical Nutrition, Children's Health, Dallas, TX, USA
| | - Kandi Trevino
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Cortney Van't Slot
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
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Tsur N, Beer Z, Rittblat M, Yaacobi D, Elmograbi A, Reuven Y. Intelligence among ear deformities and cleft lip and/or alveolus and/or cleft palate patients during 50 years in Israel. Orthod Craniofac Res 2024; 27 Suppl 1:14-20. [PMID: 37650486 DOI: 10.1111/ocr.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE We evaluated hearing loss and general intelligence among persons with auricle anomalies and cleft lip and/or alveolus and/or cleft palate (CLAP). METHODS A nationwide cross-sectional study of data recorded during 1966-2019, as mandatory pre-military recruitment of individuals. RESULTS Of 3 182 892 adolescents, 548 were diagnosed with auricle anomalies and 2072 with CLAP. For the latter, the adjusted odds ratios for the low, low to medium and medium general intelligence categories compared to the highest category were 1.4 [95% CI 1.5-1.2], 1.2 [95% CI 1.4-1.1] and 1.1 [95% CI 1.2-0.9] respectively. The corresponding values for the auricle anomalies were not significant. CONCLUSIONS General intelligence was impaired among individuals with CLAP, but no significant correlation was found among individuals suffering from auricle anomalies.
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Affiliation(s)
- Nir Tsur
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Zivan Beer
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Rittblat
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yaacobi
- Department of Plastic Surgery and Burns, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Aiman Elmograbi
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yonatan Reuven
- Department of Otolaryngology-Head and Neck Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barr J, Mackie A, Gorelik D, Buckingham H, Clark D, Brissett AE. Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38796736 DOI: 10.1002/ohn.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts. DATA SOURCES PubMed, Embase, Web of Science. REVIEW METHODS We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion. RESULTS Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (0.06%). CONCLUSION This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.
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Affiliation(s)
- Jeremy Barr
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Aaron Mackie
- School of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Daniel Gorelik
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Hannah Buckingham
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Delaney Clark
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Anthony E Brissett
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
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McKinney CM, Howard W, Bijlani K, Rahman M, Meehan A, Evans KN, Leavitt D, Sitzman TJ, Amoako-Yirenkyi P, Heike CL. Growth Patterns Between Ages 0 and 36 Months Among US Children With Orofacial Cleft: A Retrospective Cohort Study. J Acad Nutr Diet 2024:S2212-2672(24)00251-X. [PMID: 38801990 DOI: 10.1016/j.jand.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Little is known about how young children with orofacial cleft grow over time. OBJECTIVE To characterize longitudinal growth patterns from ages 0 to 36 months in US children with an orofacial cleft. DESIGN A retrospective cohort study. PARTICIPANTS/SETTING Children with cleft lip, cleft lip and palate, or cleft palate who were younger than age 36 months at a hospital encounter between 2010 and 2019 (N = 1334) were included. The setting was a US tertiary care children's hospital with a cleft center that serves a 5-state region. MAIN OUTCOME MEASURE Weight-for-age z scores (WAZ) and length-for-age z scores (LAZ). STATISTICAL ANALYSES PERFORMED Longitudinal growth patterns were characterized using generalized linear mixed models to estimate mean WAZ and LAZ from age 0 to 36 months. RESULTS Growth in infants with cleft slowed dramatically during the first 3 to 4 months of life, rebounded with catch-up growth until age 12 months for cleft lip and cleft palate and until age 36 months for cleft lip and palate. When comparing populations, children with any type of cleft demonstrated subpar growth compared with World Health Organization standards. Growth deficits were more common in those with cleft lip and palate and cleft palate compared with those with cleft lip. The intraclass coefficient showed that most of the variability in the WAZ (65%) was between individuals, whereas 35% was within an individual. The intraclass coefficient for LAZ showed that most of the variability in the LAZ (74%) was between individuals, whereas 26% was within an individual. The proportion of variance attributable to cleft type and/or comorbidities accounted for <5% of the variance for WAZ and LAZ. WAZ and LAZ were lower in children with comorbidities than those without comorbidities with cleft and World Health Organization standards. CONCLUSIONS Infants with cleft lip and palate, cleft palate, and a cleft with comorbidities have higher rates of poor growth than peers with cleft lip and a cleft with no comorbidities, respectively.
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Affiliation(s)
- Christy M McKinney
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington.
| | - Waylon Howard
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Kiley Bijlani
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Muhammad Rahman
- Seattle Children's Research Institute, Seattle, Washington; University of Washington, Seattle, Washington
| | - Anna Meehan
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Kelly N Evans
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Dawn Leavitt
- Seattle Children's Hospital, Seattle, Washington
| | | | | | - Carrie L Heike
- Seattle Children's Research Institute, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
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Chwa ES, Stoehr JR, Gosain AK. Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data. Cleft Palate Craniofac J 2024; 61:844-853. [PMID: 36594527 DOI: 10.1177/10556656221148901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. DESIGN Multi-institution, retrospective review of Smile Train Express database. SETTING 1110 Smile Train partner hospitals. PATIENTS/PARTICIPANTS 2560 patients. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. RESULTS The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. CONCLUSIONS Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.
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Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jenna R Stoehr
- Division of Plastic and Reconstructive Surgery, University of South Florida, Tampa, IL, USA
| | - Arun K Gosain
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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10
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Williams JL, Lien KM, Kirschner R, Allen G, Chapman K. Feeding Management and Palate Repair Timing in Infants with Cleft Palate with and without Pierre Robin Sequence: A Multisite Study. Cleft Palate Craniofac J 2024:10556656241239766. [PMID: 38490219 DOI: 10.1177/10556656241239766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Compare the feeding management practices in infants with cleft palate with and without Pierre Robin sequence (PRS) and determine if specific feeding difficulties or interventions predict delayed palate repair. DESIGN Retrospective cross-sectional study. SETTING Seventeen cleft palate teams contributed data. PATIENTS 414 infants were included in this study: 268 infants with cleft palate only and 146 infants with cleft palate and PRS. PROCEDURES Data were collected via parent interview and electronic health records. MAIN OUTCOME MEASURES Outcomes for the primary objective included categorical data for: history of poor growth, feeding therapy, milk fortification, use of enteral feeding, and feeding difficulties. The outcome for the secondary objective was age in months at primary palate repair. RESULTS Infants with PRS had a significantly higher prevalence of feeding difficulties (81% versus 61%) and poor growth (29% versus 15%) compared to infants with cleft palate only. Infants with PRS received all feeding interventions-including feeding therapy, milk fortification, and enteral feeding-at a significantly higher frequency. Infants with PRS underwent primary palate repair at a mean age of 13.55 months (SD = 3.29) which was significantly (P < .00001) later than infants with cleft palate only who underwent palate repair at a mean age of 12.05 months (SD = 2.36). Predictors of delayed palate repair included diagnosis of PRS as well as Hispanic ethnicity and a history of poor growth. CONCLUSIONS These findings can be used to establish clinical directives focused on providing early, multimodal feeding interventions to promote optimal growth and timely palate repair for infants with PRS.
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Affiliation(s)
- Jessica L Williams
- Phoenix Children's Center for Cleft and Craniofacial Care a Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Kari M Lien
- Department of Communication Sciences and Disorders, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Richard Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University Medical College, Columbus, OH, USA
| | - Gregory Allen
- Department of Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, College of Health, University of Utah, Salt Lake City, UT, USA
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Rafisa A, Sarilita E, Delage B, Munger RG, Mossey PA. Situational analysis of nutritional status among 1899 children presenting with cleft lip and/or palate in Indonesia. J Glob Health 2023; 13:04127. [PMID: 37856736 PMCID: PMC10586796 DOI: 10.7189/jogh.13.04127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Given the increased risk of malnutrition in children with cleft lip and/or palate (CLP), determining their nutritional status is critical for preventing adverse surgical risks. However, no such disaggregated, national-level data are available in Indonesia. We aimed to determine the nutritional status of patients with clefts in Indonesia and to identify problems and solutions for malnutrition cases within the population. Methods In this cross-sectional study, we considered records of individuals who underwent primary surgery for CLP in Smile Train-sponsored facilities in Indonesia between 1 January 2016 and 31 December 2021 (n = 18 480). We only included children under the age of five with an evaluation date prior to admission date and excluded subjects with invalid data values. We classified their nutritional status by z-scores according to the World Health Organization Child Growth Standard (2006). Malnutrition cases cover four indicators - stunting, wasting, underweight, and overweight. We compared the prevalence for malnutrition cases in children under the age of five using national health survey data. Results We included 1899 records following data validation. The national prevalence of stunting (24.4%), wasting (12.5%), and overweight cases (12.9%) was high, while underweight cases (6.8%) were comparatively low. Statistical analyses showed significant differences in nutritional status based on length/height-for-age between girls and boys aged 0-5 months (P = 0.008) and 48-60 months (P = 0.001), and based on body mass index-for-age (P = 0.000) between girls and boys aged 0-5 months. Girls in different age groups exhibited a statistically significant difference in nutritional status based on length/height-for-age (P = 0.002) and weight-for-age (P = 0.017). Concurrent stunting and overweight were the most common forms of concurrent malnutrition (8.7%). We found a significant difference in the prevalence of underweight (P = 0.001) and overweight (P = 0.000) cases between children with CLP and those without CLP. Conclusions Our findings highlight the importance of nutritional interventions for children with orofacial clefts in Indonesia, and the importance of age and gender in their design and implementation. Further investigation is necessary to explore the risks of overweight and concurrent malnutrition among this population.
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Affiliation(s)
- Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | - Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | | | - Ronald G Munger
- Centre for Epidemiologic Studies, Utah State University, Logan, Utah, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Barrero CE, Kavanagh NM, Pontell ME, Salinero LK, Wagner CS, Bartlett SP, Taylor JA, Swanson JW. Associations Between Medicaid Expansion and Timely Repair of Cleft Lip and Palate. J Craniofac Surg 2023; 34:2116-2120. [PMID: 37493139 DOI: 10.1097/scs.0000000000009524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 07/27/2023] Open
Abstract
The expansion of Medicaid under the Affordable Care Act (ACA) increased access to health care for many low-income children. However, the impact of this expansion on the timing of primary cleft lip and palate repair remains unclear. This study aimed to evaluate whether Medicaid expansion improved access to timely cleft lip and palate repair and whether it reduced preexisting ethnoracial disparities. Using a quasi-experimental design, the study analyzed data from 44 pediatric surgical centers across the United States. The results showed that Medicaid expansion was associated with a 9.0 percentage-point increase in delayed cleft lip repairs, resulting in an average delay of 16 days. Non-White patients were disproportionately affected by this delay, experiencing a 14.8 percentage-point increase compared with a 4.9 percentage-point increase for White patients. In contrast, Medicaid expansion had no significant effect on the timing of palate repair or on ethnoracial disparities in palate repair. The study underscores the importance of monitoring unintended consequences of large-scale health system changes, especially those affecting disadvantaged populations. Delayed cleft lip repair can lead to worse outcomes for patients, and the disproportionate impact on non-White patients is concerning. Further research is needed to identify the reasons for this delay and to mitigate its effects. Overall, the study highlights the need for ongoing vigilance to ensure that health care policies and interventions do not inadvertently worsen health disparities.
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Affiliation(s)
- Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Thompson RL, Thorson HL, Chinnadurai S, Tibesar RJ, Roby BB. Prenatal Consultation Outcomes for Infants With Cleft Lip With and Without Cleft Palate. Cleft Palate Craniofac J 2023; 60:1071-1077. [PMID: 35437035 DOI: 10.1177/10556656221093174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To assess the clinical impacts of prenatal consultation with a multidisciplinary cleft team on infants with cleft lip with or without cleft palate (CL ± P). Retrospective cases series. Tertiary pediatric hospital. Infants with CL ± P whose mothers received prenatal consultation with a pediatric otolaryngology team from June 2005 to December 2019 were identified. A random sample of infants with CL ± P without prenatal consultation from June 2005 to December 2019 was also identified. The primary outcomes were the length of hospitalization during the first 12 weeks of life, timing of surgical repair, length of postsurgical hospitalization, and number of unplanned clinic visits and phone calls for feeding evaluation. Time to cleft lip repair differed significantly between the 2 groups with repair performed at 13.4 (±0.9) weeks for the prenatal consultation group (n = 73) and 15.3 (±2.1) weeks for the control group (n = 80), (P < .05). If hospitalization was required for feeding difficulties during the first 12 weeks of life, length of stay was 4.9 (± 1.7) days for infants with prenatal consultation and 11.5 (± 7.2) days for control infants (P < .05). Unplanned clinic visits with a speech-language pathologist (SLP) for feeding difficulties were needed for 2.7% of prenatal consultation infants and 11.3% of control infants (P < .05). Prenatal consultation regarding CL ± P resulted in infants with decreased duration of early hospitalizations, earlier cleft lip repair, and decreased engagement with the SLP feeding clinic for feeding difficulties when compared with infants without prenatal consultation.
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Affiliation(s)
| | - Heidi L Thorson
- Minnesota Perinatal Physicians, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Sivakumar Chinnadurai
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
| | - Robert J Tibesar
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
| | - Brianne B Roby
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
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Zhang B, Zhang Y, Wu S, Ma D, Ma J. DNA methylation profile of lip tissue from congenital nonsyndromic cleft lip and palate patients by whole-genome bisulfite sequencing. Birth Defects Res 2023; 115:205-217. [PMID: 36210532 PMCID: PMC10092010 DOI: 10.1002/bdr2.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 01/29/2023]
Abstract
Congenital nonsyndromic cleft lip and palate (NSCLP) is one of the most common malformations worldwide. DNA methylation has been implicated in many diseases. However, its involvement in lip tissue from NSCLP is not well understood. This study aimed to investigate the role of dysregulated DNA methylation in NSCLP. DNA methylation profile was determined in eight injured and five self-normal lip tissue samples from children with NSCLP by whole-genome bisulfite sequencing. A total of 2,711 differentially methylated regions (DMRs), corresponding to 1,231 genes were identified. Given the important role of promoter methylation in regulating gene expression, the promoter DMR-related genes were considered. Bioinformatics analysis demonstrated that some of them showed potential associations with NSCLP. Therefore, the well-known NSCLP susceptibility gene, GLI family zinc finger 2 (GLI2) with an unknown role in its DNA methylation in NSCLP, was selected for further analysis. The promoter hypomethylation and higher mRNA expression level of GLI2 were observed in injured lip tissues by verification in additional samples. Moreover, dual luciferase reporter assay indicated that promoter hypermethylation of GLI2 inhibited its transcription. Overall, this study suggested that abnormal DNA methylation in lip tissue may be correlated with the pathogenesis of congenital NSCLP.
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Affiliation(s)
- Bowen Zhang
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, ENT Institute, Fudan University, Shanghai, China.,Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Youmeng Zhang
- Department of Stomatology Stomatology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Siyi Wu
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, ENT Institute, Fudan University, Shanghai, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jing Ma
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, ENT Institute, Fudan University, Shanghai, China
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15
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Taufique ZM, Escher PJ, Gathman TJ, Nickel AJ, Lee DB, Roby BB, Chinnadurai S. Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate. Laryngoscope 2021; 132:1482-1486. [PMID: 34665463 DOI: 10.1002/lary.29899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with cleft lip and/or palate (CLP) are at increased risk of malnutrition. Acute and chronic malnutrition have been associated with elevated risk of postsurgical wound complications, adding morbidity and cost to patients and their families. To study the association between demographic factors, including insurance type, race, and median neighborhood income (MNI), and malnutrition in patients with CLP. STUDY DESIGN Retrospective cohort study. METHODS Retrospective review was performed in patients undergoing their first cleft-related surgery at a large tertiary pediatric hospital from 2006 to 2018. Demographic data, weight and height at surgery, type of insurance, race, and primary residential address were collected. Geocoded information on MNI was generated using patient address. World Health Organization Z-scores for weight-for-age (WFA) and height-for-age (HFA) were used as proxies for acute and chronic malnutrition, respectively. Linear regression models were generated to analyze the relationship of insurance type, race, and MNI on WFA and HFA Z-scores. RESULTS About 313 patients met inclusion criteria. Increasing MNI predicted increasing WFA Z-score (0.05 increase in WFA per $1,000 increase, P = .047) as well as HFA Z-score (0.09 increase in HFA per $1,000 increase, P = .011). The effect of MNI was not independently modified by race for either WFA (P = .841) nor HFA (P = .404). Race and insurance type did not predict WFA or HFA. CONCLUSIONS Lower MNI is a significant independent risk factor for acute and chronic malnutrition in children with CLP. Combined with previous investigation linking malnutrition to surgical outcomes in this population, this offers a target area for intervention to improve patient outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Zahrah M Taufique
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Paul J Escher
- University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A
| | - Tyler J Gathman
- University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A
| | - Amanda J Nickel
- Children's Research Institute, Children's Minnesota, Minneapolis, Minnesota, U.S.A
| | - Daniel B Lee
- Amherst H. Wilder Foundation, Saint Paul, Minnesota, U.S.A
| | - Brianne B Roby
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Sivakumar Chinnadurai
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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