Assessment of stature in children with orofacial clefting

Growth Patterns Between Ages 0 and 36 Months Among US Children With Orofacial Cleft: A Retrospective Cohort Study

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.

Sella turcica dimensions and maxillary growth in patients with unilateral cleft lip and palate

OBJECTIVES

We aimed to investigate associations between sella turcica dimensions and maxillary growth in children with unilateral cleft lip and palate (UCLP).

METHODS

Forty-nine patients with non-syndromic UCLP, prior to secondary alveolar bone-grafting, were included. The outcomes measured were sella turcica and maxillary cephalometric measurements, and scores representing dental arch relationships derived from dental casts. On lateral cephalograms, sella width, height, and area were measured, as well as maxillary length, height, protrusion, and inclination. Dental arch relationships were measured using the modified Huddart/Bodenham (MHB) scoring system, and translated GOSLON yardstick score. Multiple linear regression was used to assess associations between sella turcica measurements and either cephalometric parameters or MHB/GOSLON scores, including age and sex as covariables.

RESULTS

No significant associations were found between sella turcica dimensions and dental arch relationships. For cephalometric measurements, sella height and area were associated with basal maxillary length, alveolar maxillary length, and anterior maxillary height.

CONCLUSIONS

Sella height and area seem to be predictors for both maxillary length and height as assessed cephalometrically, in a sample of patients with non-syndromic UCLP.

Sella turcica morphometrics in children with unilateral cleft lip and palate

OBJECTIVE

To use morphometric methods to investigate the size and shape of the sella turcica in children with unilateral cleft lip and palate (UCLP).

SETTING AND SAMPLE POPULATION

Fifty-six healthy children with non-syndromic UCLP, from a major paediatric teaching hospital, with lateral cephalograms taken prior to alveolar bone grafting, were compared with an age- and sex-matched control group of healthy children without orofacial clefts, with lateral cephalograms taken prior to orthodontic treatment.

MATERIALS AND METHODS

In this cross-sectional study, conventional measurements were performed on the sella turcica to measure width, height and area on lateral cephalograms. Sella shape was also analysed using 11 points defining the sella turcica contours, using geometric morphometrics. Procrustes superimposition was used to register all sella contour tracings to calculate average sella shape. Principal component analysis was applied to the residuals of the point coordinates, and principal components (PCs) of shape were extracted.

RESULTS

Statistically significant differences between the UCLP and control groups were found for sella posterior height, midpoint height, maximum height and area, where all of these were smaller in children with UCLP. Principal component analysis revealed that the first two PCs accounted for 84.7% of total shape variance. There was a statistically significant difference in sella shape between children with UCLP and control children.

CONCLUSIONS

In children with UCLP, the sella turcica is shorter and with a smaller surface area when compared to matched non-cleft children. Moreover, sella turcica shape, when disregarding size, seems to differ to that of non-cleft children.

Body Mass Index and Association With Caries in School-Aged Children With Orofacial Cleft: A Case-Control Study

OBJECTIVE

Data on the association between body mass index (BMI) and dental caries in children with orofacial clefts are sparse. Therefore, studies on the impact of BMI on caries frequency in children with cleft lip and/or palate (CL/P) are of importance. The aim of the current study was to investigate the association between BMI and frequency of dental caries in children with and without CL/P. Height, weight, and BMI in children with CL/P were also compared to controls.

DESIGN

This study used a cross-sectional case-control design.

PARTICIPANTS

One hundred and thirty-nine 5- and 10-year-old children with CL/P and 299 age-matched controls.

MAIN OUTCOME MEASURES

Caries was recorded according to the International Caries Detection and Assessment System. Height and weight were recorded, and BMI was calculated as weight/height².

RESULTS

There was no correlation between BMI and caries frequency. Weight, height, and BMI were significantly lower in all children with CL/P compared to controls. After adjustment for international adoption, only BMI was significantly lower in CL/P children compared to controls. Non-adopted children with CL/P were significantly heavier and longer than adopted children with CL/P.

CONCLUSIONS

Five- and 10-year-old children with corrected CL/P seemed to have a lower BMI than controls, but there was no association between BMI and caries frequency. Internationally adopted children with CL/P were lighter and shorter than non-adopted CL/P children and controls.

The estimation of skeletal maturity of patients with cleft lip and palate using statistical shape analysis: a preliminary study

OBJECTIVES

To propose a skeletal maturity assessment method by developing a statistical regression analysis model through the integration of lateral and axial images of the cervical vertebrae of patients with cleft lip and palate obtained through CBCT.

METHODS

49 patients with cleft lip and palate (28 females, 21 males; age range, 4-16 years) underwent CBCT examination, and the hand-wrist radiographic data were selected. With coordinates of landmarks from lateral and axial images of the cervical vertebrae, Procrustes analysis and principal component (PC) analysis yielded PC scores of each cervical vertebra, with the centroid size as the size factor. The meaningful PC scores from these were used for multiple regression models.

RESULTS

When both axial and lateral cervical vertebrae were used together, there was a 6.7% increase in the Sempé maturation level explanatory power for skeletal maturation estimation in females and an 11.4% increase in males compared with that when only the chronological age was used.

CONCLUSIONS

This study improved the estimating regression models using statistical shape analysis with lateral and axial cervical vertebral shapes. The obtained models had improved explanatory power for skeletal maturity estimation than previous studies with healthy people.

Cervical vertebral maturation of female children with orofacial clefts

Objective : To evaluate the skeletal maturation of girls with orofacial clefts using the cervical vertebral maturation method. Design : Case-control study. Setting : The School of Stomatology, Peking University. Patients : A total of 173 girls with cleft lip and/or palate from 8 to 16 years old were compared with 1038 age-matched girls without clefts. Results : In the 8- to 9-year-olds, most of the girls from both groups were in cervical stage 1. In the 14- to 15-year-olds and 15- to 16-year-olds, almost all the girls from both groups were in cervical stages 5 and 6, and most of the 15- to 16-year-old girls were in cervical stage 6. Differences existed in each year for 9- to 14-year-olds, which was confirmed by statistical analysis. After ordinal logistical regression of data from girls 9 to 14 years of age, girls of the same age in the non-cleft lip and/or palate group were associated with 1.559 times the odds of having achieved higher cervical stages than those in the cleft lip and/or palate group. Most girls without cleft lip and/or palate were in cervical stages 3 and 4 in the 11- to 12-year-olds; whereas, it was not so obvious in the girls with cleft lip and/or palate. By the age of 12, girls with cleft lip and/or palate had 2.667 times the risk of delayed cervical stage 3, and the 95% confidence interval for the odds ratio was 1.013 to 7.019. Conclusions : Girls with cleft lip and/or palate are at a higher risk of delayed pubertal growth.

Longitudinal Study of Growth of Children with Unilateral Cleft Lip and Palate: 2 to 10 Years of Age

Objective

To study the growth of children with complete unilateral cleft lip and palate (UCLP) from 2 to 10 years of age and to assess whether growth varied from that of children without UCLP (typical children).

Design

Physical growth was one of the outcome measures of a National Institutes of Health–sponsored longitudinal, prospective clinical trial conducted by the University of Florida and the University of São Paulo.

Setting

Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Bauru, Brazil.

Main Outcome Measures

Height and weight were prospectively measured for 360 healthy children with UCLP who were nonsyndromic, belonged to median socioeconomic status, and received health care at HRAC-USP. To compare growth of children with UCLP to that of typical children, growth curves for UCLP were developed and compared with World Health Organization curves for 2006 and 2007, which were used as reference for typical children. Third-degree polynomials were used to explain the relationship of length and weight with age. Confidence limits of 95% were used for the mean curve using the statistic Z ~ N (0,1).

Results

Children with UCLP from 2 to 10 years old presented height and weight growth curves similar to those of typical children for both genders.

Conclusion

Children with UCLP from 2 to 10 years old presented physical growth similar to that of typical children.

Impact of sleep and breathing in infancy on outcomes at three years of age for children with cleft lip and/or palate

STUDY OBJECTIVES

To evaluate the relationship between sleep disordered breathing (SDB) in early infancy and outcomes at 3 years of age in children with cleft lip and/or palate (CL/P).

DESIGN

Observational follow-up study.

SETTING

Multidisciplinary CL/P clinic, tertiary centre.

PARTICIPANTS

Children with CL/P who participated in a study of sleep and breathing in infancy.

MEASUREMENTS AND RESULTS

The families of 52 children were approached for this follow-up study. The children underwent neurocognitive (Bayley Scales of Infant and Toddler Development, Third Edition; BSID-III), quality of life (Infant/Toddler Quality of Life Questionnaire; ITQOL), and growth assessments at 3 years. The families of 33 children (66%) completed follow-up at 36.7 ± 1.4 months. The apnea-hypopnea index (AHI) in infancy was 23.9 ± 18.0 events/h. Mean group BSID-III scores fell within the standardized normal range (10 ± 3) for all domains; however, language scores were lower than control children. Quality of life scores and growth parameter z-scores were similar to published control data. PSG variables in infancy showed significant relationships with outcomes at 3 years of age; lower percentage of AS/REM sleep was associated with lower cognition score; more obstructive events were associated with lower global behavior ITQOL score; and higher number of respiratory events in infancy was associated with lower weight z-score.

CONCLUSION

Neurocognition, quality of life, and growth measures from children with CL/P fall within a normal range; however, scores in the language domain are lower than controls. Sleep and respiratory elements of SDB in infancy appear to modify these outcomes at 3 years of age.

Height, BMI, and pituitary volume in individuals with and without isolated cleft lip and/or palate

INTRODUCTION

Individuals with isolated cleft lip and/or palate (ICLP) are often reported to be of shorter stature relative to peers, and the objective of this study was to explore the role of the pituitary in relationship to growth.

METHODS

Fifty-five males and 32 females with ICLP were compared to 121 healthy males and 158 healthy females with respect to height and BMI. Magnetic resonance imaging (MRI) scans were obtained from all ICLP participants and 47% of healthy group participants.

RESULTS

Males with ICLP were shorter than healthy males and had lower BMI. However, the trajectories for height and BMI did not differ between groups. Analyses in a separate sample of adult males suggested that height normalizes in males with ICLP in their early 30s. There were no differences in mean pituitary volume and pituitary trajectories between male groups. Females with ICLP were shorter than healthy females and also had slower growth rates. They did not differ in mean BMI or BMI trajectories. Furthermore, there were no differences in mean pituitary volume, or in pituitary trajectories.

DISCUSSION

Our findings suggest that there are no gross morphological differences in pituitary volume in individuals with ICLP, although more subtle differences may exist.

Cervical vertebral maturation of children with orofacial clefts

OBJECTIVE

To evaluate the skeletal maturation of male children with orofacial clefts using the cervical vertebral maturation (CVM) method.

DESIGN

Case-control study.

SETTING

The School of Stomatology, Peking University.

PATIENTS

Subjects were 443 boys with cleft lip and/or cleft palate (CL/P) aged 8 to 16 years who were compared with 1772 boys without clefts in an age-matched control group.

RESULTS

The 8- to 10-year-old boys of both groups were in CS1. Most of the 11- to 14-year-old boys without CL/P were in CS3 and CS4, though it was not so obvious in boys with CL/P. Most 15- to 16-year-old boys without CL/P were in CS5 and CS6, while there were a lot of boys with CL/P who were still in cervical stages before CS5. Clefts had a significant effect on growth, and boys without CL/P were 1.737 times more likely to have achieved higher cervical stages. From Mann-Whitney test of every age phase, the difference existed in each year of the age range of 11 to 16 years, except from 12 to 13 years (p  =  .100). In these age phases, the cervical stages of boys with CL/P were lower than those for boys without CL/P. By the age of 14, children with CL/P had a 4.679 times higher risk of delayed CS3, and the 95% confidence interval for the odds ratio was 2.129 to 10.286.

CONCLUSIONS

Boys with CL/P are at a higher risk of delayed growth period and retarded pubertal growth peak.

Growth in infants in the first two years of life after neonatal repair for unilateral cleft lip and palate

OBJECTIVE

To evaluate the growth during the first two years of life in infants after unilateral cleft lip and palate neonatal repair.

METHOD

All mature infants with nonsyndromic unilateral cleft lip and palate (NSUCLP) born between 2004 and 2007 were included. Information concerning growth was collected. Weight and length at birth, 6, 12, 18 and 24 months of age measurements and data regarding feeding were obtained.

RESULTS

Weight and length at birth, 6, 12, 18 and 24 months of age were identical with reference curve values. Children with NSUCLP showed a normal growth at two years. The weight curves lie between 5th and the 50th percentile for girls and between 10th and higher than the 97th percentile for boys. The height curves lie between -1 Standard Deviation and +1 Standard Deviation for girls and 0 and +2 Standard Deviation for boys.

CONCLUSION

Feeding difficulties are reported in infants with cleft lip and/or palate CLP/CP. However, the growth in children with NSUCLP and after neonatal cleft lip repair is identical with reference curve values.

Longitudinal Study of Growth of Children with Unilateral Cleft-Lip Palate from Birth to Two Years of Age

Objective:

To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves.

Design:

Physical growth was a secondary outcome measure of a National Institutes of Health–sponsored longitudinal, prospective clinical trial involving the University of Florida (United States) and the University of São Paulo (Brazil).

Patients:

Six hundred twenty-seven children with UCLP, nonsyndromic, both genders.

Methods:

Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the three parameters (length, weight, head circumference) were performed and compared with the median for the National Center for Health Statistics (NCHS) curves. The median values for length, weight, and head circumference at birth and 6, 12, 18, and 24 months of age were plotted against NCHS median values and statistically compared at birth and 24 months.

Setting:

Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP).

Results:

At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a catch-up growth for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys.

Conclusions:

Weight was the most compromised parameter for both genders, followed by length and then head circumference. There was no evidence of short stature. This study established growth curves for children with UCLP.

Cleft lip and/or palate and breathing during sleep

Cleft of the lip and/or palate (CL/P) is a common defect which is associated with changes in facial structures and a smaller upper airway. As a result, infants and children with CL/P have an increased risk of sleep disordered breathing (SDB). This paper will review the anatomical and functional factors which place infants and children with CL/P at increased risk of SDB as well as review the literature which defines the magnitude of this risk. The information available on treatment of SDB in infants and children with CL/P will be presented. Finally, outstanding issues relevant to SDB in children with CL/P are discussed with direction for future research.

Physical characteristics of young men with cleft lip, with or without cleft palate, and cleft palate only

We report the weight, stature, body mass index (BMI), and muscular strength of men about 19 years old who have cleft lip, either with or without cleft palate (CLP), or cleft palate only (CP). Data were obtained from the Swedish National Service enrolment register for the years 1991 -97, and concerned 335 men with CLP and 88 with CP, who were compared with a control group of 272 879 men. The data showed that those with CLP and CP were significantly lighter than controls. Their stature in the CLP group was similar to that in controls, but those with CP significantly shorter. These findings imply that men with CLP had a significantly lower BMI whereas men with CP had a similar BMI compared with controls. Those with CLP did not differ as regards to muscular strength, but those with CP were significantly weaker than controls.

Assessment of growth and immunologic function in HIV-infected and exposed children

Many children who are HIV infected grow poorly. An epidemiological framework guided a retrospective chart review assessing growth in three groups of children (n = 192): (a) children who were HIV infected secondary to maternal transmission (n = 77), (b) children who had been HIV-positive at birth but became seronegative and continue to be observed (seroreverters) (n = 84), and (c) HIV-infected children who had died (n = 31). Growth failure in the HIV-infected children was significantly greater than that expected in the general population. The seroreverters also demonstrated significantly more growth failure than that expected in the general population. Of the children who had linear growth failure, only 3 of 12 HIV-infected children and 2 of 11 seroreverters also had inadequate weight gain. However, 13 of 15 children with growth failure who subsequently died had poor weight gain. HIV classification was not significantly related to growth. These findings extend our understanding to a large, urban population of children in the United States including those who are older than children in other studies and who developed HIV through perinatal transmission. Nursing clinical practice and research implications are offered.