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Herrera S, Pierrat V, Kaminski M, Benhammou V, Marchand-Martin L, Morgan AS, Le Norcy E, Ancel PY, Germa A. Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study. Front Pediatr 2022; 10:784911. [PMID: 35498807 PMCID: PMC9051072 DOI: 10.3389/fped.2022.784911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Children born very preterm have an immature sucking reflex at birth and are exposed to neonatal care that can impede proper palate growth. OBJECTIVES We aimed to describe the frequency of high-arched palate and posterior crossbite at the age of 5 in children born very preterm and to identify their respective risk factors. METHODS Our study was based on the data from EPIPAGE-2, a French national prospective cohort study, and included 2,594 children born between 24- and 31-week gestation. Outcomes were high-arched palate and posterior crossbite. Multivariable models estimated by generalized estimation equations with multiple imputation were used to study the association between the potential risk factors studied and each outcome. RESULTS Overall, 8% of children born very preterm had a high-arched palate and 15% posterior crossbite. The odds of high-arched palate were increased for children with low gestational age (24-29 vs. 30-31 weeks of gestation) [adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.17, 2.66], thumb-sucking habits at the age of 2 (aOR 1.53, 95% CI 1.03, 2.28), and cerebral palsy (aOR 2.18, 95% CI 1.28, 3.69). The odds of posterior crossbite were increased for children with pacifier-sucking habits at the age of 2 (aOR 1.75, 95% CI 1.30, 2.36). CONCLUSIONS Among very preterm children, low gestational age and cerebral palsy are the specific risk factors for a high-arched palate. High-arched palate and posterior crossbite share non-nutritive sucking habits as a common risk factor. The oro-facial growth of these children should be monitored.
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Affiliation(s)
- Sandra Herrera
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Véronique Pierrat
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Monique Kaminski
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Valérie Benhammou
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Laetitia Marchand-Martin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France
| | - Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.,Department of Neonatal Medicine, Maternité Port-Royal, Paris, France
| | | | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,Clinical Research Unit, Centre for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Alice Germa
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.,Department of Odontology, APHP, Charles Foix Hospital, Ivry-sur-Seine, France
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Pamukcu U, Dal A, Altuntas N, Cınar C, Altunkaynak B, Peker I. Knowledge, behavior, and awareness of neonatologists and anesthesiologists about oral complications of intubation and protection methods. Int Dent J 2020; 70:374-380. [PMID: 32368806 DOI: 10.1111/idj.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aimed to assess awareness of anesthesiologists and neonatologists about oral complications occurring during and after the orotracheal intubation (OTI) in premature infants and their knowledge and behavior regarding protection methods from these complications in clinical practice. METHODS This study included 94 neonatologists and 137 anesthesiologist. The final version of the questionnaire included 15 items in three main parts: (i) personal information; (ii) awareness about oral complications occurring during and after the OTI in premature infants; (iii) knowledge and behavior regarding protection methods from these complications in clinical practice. RESULTS A total of 95.7% of neonatologists and 83.2% of anesthesiologists were aware of oral complications related to OTI. The most common complications the anesthesiologists encountered were oral, laryngeal, or pharyngeal region injuries (60.7%) and palatal groove (52.2%) for the neonatologists. The most preferred method for stabilization of the orotracheal intubation tube (OTT) was bonding to the perioral region with an adhesive tape (98.3%). The primary determining factor in the choice of OTT stabilization method was the ease of use (28.2%). A total of 23.8% of the participants were aware of the palatal stabilization device (PSD), whereas only 1.3% used it in their routine and 57.1% of them believed it can prevent complications. CONCLUSIONS The results showed that neonatologists were more aware of the OTI-related oral complications than anesthesiologists. The knowledge of the participants regarding prevention of these complications is insufficient. Study participants believe in the efficacy of PSD but do not use it in clinical practice for a number of reasons.
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Affiliation(s)
- Umut Pamukcu
- Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Aycan Dal
- Department of Pedodontics, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Nilgun Altuntas
- Newborn Department, Ankara Yıldırım Beyazıt University Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Cagdas Cınar
- Department of Pedodontics, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Bulent Altunkaynak
- Department of Statistics, Faculty of Sciences, Gazi University, Ankara, Turkey
| | - Ilkay Peker
- Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry, Ankara, Turkey
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Geddes D, Kok C, Nancarrow K, Hepworth A, Simmer K. Preterm Infant Feeding: A Mechanistic Comparison between a Vacuum Triggered Novel Teat and Breastfeeding. Nutrients 2018; 10:nu10030376. [PMID: 29562703 PMCID: PMC5872794 DOI: 10.3390/nu10030376] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 12/14/2022] Open
Abstract
The goal for preterm infants is to achieve full oral feeds quickly and ultimately progress to full breastfeeding. Supplementary oral feeds are often given when the mother is not available to breastfeed. Bottles typically deliver milk in a different fashion compared to breastfeeding, which is thought to hamper transition to full breastfeeding. The aim of this study was to compare the sucking dynamics of preterm infants fed at the breast to feeding with an experimental novel teat (NT) designed to release milk only upon the application of vacuum. Simultaneous ultrasound imaging of the infant oral cavity and measurement of intra-oral vacuum was performed during a breastfeed and a feed with the NT. Test weighs were used to measure milk intake. Linear mixed effects models were performed to investigate differences by feed type, and simultaneous linear regression was performed to investigate individual patterns. Tongue movement was not different between breastfeeding and the NT. Intra-oral vacuums (median (interquartile range: IQR)) were significantly lower with the NT (Baseline vacuum: -5.8 mmHg (-11.0, 0.1); Peak: 40.0 mmHg (-54.6, -27.1)) compared to breastfeeding (Baseline: -31.1 mmHg (-60.0, -12.7); Peak: -106.2 mmHg (-153.0, -65.5)). Milk intake was significantly higher with the NT (33 mL (22.5, 42.5)) compared to the breastfeed (12 mL (3, 15.5)). The novel teat encouraged a similar tongue action to breastfeeding, and infants transferred a greater volume of milk with the novel teat. Intra-oral vacuums were lower in strength with the novel teat compared to the breast. Use of the novel teat for the training of sucking dynamics in preterm infants has the potential to improve breastfeeding success and requires further investigation.
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Affiliation(s)
- Donna Geddes
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Perth, WA 6009, Australia.
| | - Chooi Kok
- Centre for Neonatal Research and Education, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia.
- The Neonatal Directorate, King Edward Memorial Hospital, Perth, WA 6008, Australia.
| | - Kathryn Nancarrow
- Centre for Neonatal Research and Education, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia.
- The Neonatal Directorate, King Edward Memorial Hospital, Perth, WA 6008, Australia.
| | - Anna Hepworth
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Perth, WA 6009, Australia.
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia.
- The Neonatal Directorate, King Edward Memorial Hospital, Perth, WA 6008, Australia.
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Enomoto M, Sezaki H, Muranishi R, Sato Y, Kikuchi S, Katayama Y, Takei A, Ikegami H, Sakuma M, Minami H. Acquired palatal groove and delayed oral feeding in preterm infants. Pediatr Int 2017; 59:171-175. [PMID: 27501257 DOI: 10.1111/ped.13113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/11/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acquired palatal groove has been reported in the 1970s and 1980s, but its current incidence in Japanese newborns is unclear. The aims of this study were to determine the incidence of palatal groove in preterm infants and to evaluate whether this condition affects oral feeding ability. METHODS We conducted a prospective observational study among very low-birthweight infants born at Takatsuki General Hospital, Osaka, between March and October in 2010. The shape of the hard palate was classified into three types: normal, narrow high-arched palate, and palatal groove. RESULTS Among the 37 enrolled infants, 14 (38%) had palatal groove. In particular, among the 29 infants with birthweight <1000 g, palatal groove was observed in 48% of these patients, and only 10% were normal. Infants with palatal groove were ventilated for considerably more days with oral endotracheal tube than those without palate groove, even after adjustment for gestational age, birthweight, and duration of oral duodenal tube placement (OR, 1.11). Establishment of oral feeding and disappearance of choking on milk were considerably delayed in infants with palatal groove. Transient oral feeding difficulty requiring thickened-feed intervention was observed only in infants with palatal groove; on multi-regression analysis this difficulty seemed to be induced by the palatal groove. CONCLUSIONS Palatal groove formation induced by oral endotracheal intubation occurs with a high frequency in preterm infants, and this is likely to affect oral feeding ability.
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Affiliation(s)
- Masahiro Enomoto
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Hiromi Sezaki
- Neonatal Intensive Care Unit, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Rie Muranishi
- Neonatal Intensive Care Unit, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Yumi Sato
- Neonatal Intensive Care Unit, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Shin Kikuchi
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Yoshinori Katayama
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Atsuko Takei
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Hitoshi Ikegami
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirotaka Minami
- Department of Pediatrics and Neonatology, Takatsuki General Hospital, Takatsuki, Osaka, Japan
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Cortines AAO, Costa LR. Associated factors and persistence of palatal groove in preterm infants: a cohort study. BMC Pediatr 2016; 16:143. [PMID: 27558593 PMCID: PMC4995662 DOI: 10.1186/s12887-016-0671-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of evidence on the relationship between prematurity and palatal abnormalities. The aim of this study was to evaluate the incidence of palatal groove, the associated factors and the persistence time in preterm infants from birth to 24 months of age. METHODS The children's data, medical history and eating habits were collected using a questionnaire answered by the legal guardian and updated every dental visit. Natal and neonatal data were obtained from the medical records. During the orofacial examination, the presence or absence of a palatal groove was observed. In order to evaluate for associations between independent variables and the palatal groove, descriptive analyses and bivariate analyses were conducted using the Mann-Whitney, Pearson's chi-squared and Fisher's exact tests, when appropriate. The Poisson regression analysis was used to determine risk and protective factors for the occurrence of palatal groove. The significance level was 0.05. For the persistence of palatal groove, a survival analysis was used (Kaplan Meier method). RESULTS Seventy-four preterm infants were monitored. Palatal groove occurred in n = 19 (25.7 %) and persisted for an average time of 12 months. Bivariate analysis showed a significantly higher occurrence of palatal groove in girls (68.4 % vs 40 % with non-occurrence of palatal groove) as well as in infants that stayed longer in the neonatal intensive care unit (NICU) (median 37 days vs 20 days), that did not have exclusive breastfeeding (94.7 % vs 69.1 %), were intubated (median five days vs one day) or used an orogastric tube (median 33 days vs 15 days). The quantitative data for 'NICU', 'intubation' and 'orogastric tube' were correlated and estimated as risk factors for palatal groove formation in the unadjusted Poisson regression analysis. CONCLUSIONS Palatal groove occur transiently in approximately one quarter of preterm infants, especially in infants that stay longer in the NICU, are intubated or use an orogastric tube.
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Affiliation(s)
| | - Luciane R Costa
- Faculty of Dentistry, Universidade Federal de Goias, Primeira Avenida, s/n, Setor Universitario, Goiania, Goias, 74605-220, Brazil.
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Germa A, Marret S, Thiriez G, Rousseau S, Hascoët JM, Paulsson-Björnsson L, Söderfeldt B, Ancel PY, Larroque B, Kaminski M, Nabet C. Neonatal factors associated with alteration of palatal morphology in very preterm children: the EPIPAGE cohort study. Early Hum Dev 2012; 88:413-20. [PMID: 22088785 DOI: 10.1016/j.earlhumdev.2011.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/14/2011] [Accepted: 10/01/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Altered palatal morphology has been observed among some preterm children, with possible consequences on chewing, speaking and esthetics, but determinants remain unknown. AIM To explore the role of neonatal characteristics and neuromotor dysfunction in alteration of palatal morphology at 5 years of age in very preterm children. STUDY DESIGN Prospective population-based cohort study. SUBJECTS 1711 children born between 22 and 32 weeks of gestation in 1997 or born between 22 and 26 weeks of gestation in 1998 were included in the study. They all had a medical examination at 5 years of age. OUTCOME MEASURES Alteration of palatal morphology. RESULTS The prevalence of altered palatal morphology was 3.7% in the overall sample, 5.1% among boys and 2.2% among girls (adj OR: 2.52; 95%CI: 1.44-4.42). The risk for altered palatal morphology was higher for lower gestational age (adj OR: 0.85; 95%CI: 0.74-0.97 per week), small-for-gestational age children (adj OR: 2.11; 95%CI: 1.20-3.72) or children intubated for more than 28 days (adj OR: 3.16; 95%CI: 1.11-8.98). Altered palatal morphology was more common in case of cerebral palsy or moderate neuromotor dysfunction assessed at 5 years. Results were basically the same when neuromotor dysfunction was taken into account, except for intubation. CONCLUSION Male sex, low gestational age, small-for-gestational age and long intubation have been identified as probable neonatal risk factors for alteration of palatal morphology at 5 years of age in very preterm children. Further studies are needed to confirm these results.
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Affiliation(s)
- Alice Germa
- Institut National de la Santé et de la Recherche Médicale Unit 953, Epidemiological Research Unit in Perinatal Health, Children and Women's Health, Villejuif, France.
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Abstract
Children with respiratory disorders are at risk of compromised oral health. It has been shown that both dental hard tissue damage (dental caries, dental erosion, mild enamel developmental defects) and soft tissue damage (gingivitis, periodontal disease and calculus formation) are more likely for such children. The aetiology of this increased risk of oral health problems is associated both with the illness itself and/or the drug therapies used. Oral health management strategies for the home and surgery are outlined.
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Affiliation(s)
- Richard P Widmer
- Clinical Associate Professor, Department Head, Department of Dentistry, The Children's Hospital at Westmead, NSW, Australia.
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