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Lehmann CU, Adams WG, Chaparro JD, Fiks AG, Grout RW, Leu MG, Mendonca EA, Michel JJ, Okechukwu K, Salmon J, Sharifi M, Downs SM. Better Guidelines and Policies: AAP's Partnership for Policy Implementation. Pediatrics 2024; 154:e2023061360. [PMID: 38864111 DOI: 10.1542/peds.2023-061360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES In 2005, the American Academy of Pediatrics founded the Partnership for Policy Implementation (PPI). The PPI has collaborated with authors to improve the quality of clinical guidelines, technical reports, and policies that standardize care delivery, improve care quality and patient outcomes, and reduce variation and costs. METHODS In this article, we describe how the PPI trained informaticians apply a variety of tools and techniques to these guidance documents, eliminating ambiguity in clinical recommendations and allowing guideline recommendations to be implemented by practicing clinicians and electronic health record (EHR) developers more easily. RESULTS Since its inception, the PPI has participated in the development of 45 published and 27 in-progress clinical practice guidelines, policy statements, technical and clinical reports, and other projects endorsed by the American Academy of Pediatrics. The partnership has trained informaticians to apply a variety of tools and techniques to eliminate ambiguity or lack of decidability and can be implemented by practicing clinicians and EHR developers. CONCLUSIONS With the increasing use of EHRs in pediatrics, the need for medical societies to improve the clarity, decidability, and actionability of their guidelines has become more important than ever.
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Affiliation(s)
- Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William G Adams
- Boston Medical Center/BU Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Juan D Chaparro
- Department of Pediatrics, The Ohio State University College of Medicine; Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio
| | - Alexander G Fiks
- Clinical Futures (A Research Institute Center of Emphasis) and Department of Biomedical Informatics, Children's Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Randall W Grout
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana Regenstrief Institute, Inc, Indianapolis, Indiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education and UW Medicine IT Services, University of Washington, Seattle, Washington Seattle Children's Hospital, Seattle, Washington
| | - Eneida A Mendonca
- Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics and Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeremy J Michel
- Department of Biomedical Informatics, Children's Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania ECRI Guidelines Trust, ECRI, Plymouth Meeting, Pennsylvania
| | | | | | - Mona Sharifi
- Department of Pediatrics, Center for Medical Informatics, Center for Implementation Science, Yale University School of Medicine, New Haven, Connecticut
| | - Stephen M Downs
- Department of Pediatrics and Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Denadai R, Lo LJ. Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns. J Pediatr (Rio J) 2024; 100:350-359. [PMID: 38307119 DOI: 10.1016/j.jped.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. SOURCE OF DATA PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. SUMMARY OF THE FINDINGS Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age- and condition-specific protocols. CONCLUSIONS Encouraging neonatologists and pediatricians, who are the first to examine newborns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system.
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Affiliation(s)
- Rafael Denadai
- Centro Avançado de Cirurgia Plástica Facial, A&D DermePlastique, São Paulo, SP, Brazil; Centro Universitário Max Planck (UniMAX), Faculdade de Medicina, Indaiatuba, SP, Brazil; Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan.
| | - Lun-Jou Lo
- Chang Gung Memorial Hospital, Craniofacial Research Center, Taoyuan, Taiwan; Chang Gung University, Chang Gung Memorial Hospital, Department of Plastic and Reconstructive Surgery, Taoyuan, Taiwan
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Li YY, Tse WT, Kong CW, Wong NKL, Leung TY, Choy KW, To WWK, Cao Y. Prenatal Diagnosis and Pregnancy Outcomes of Fetuses With Orofacial Cleft: A Retrospective Cohort Study in Two Centres in Hong Kong. Cleft Palate Craniofac J 2024; 61:391-399. [PMID: 36128746 DOI: 10.1177/10556656221128436] [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
OBJECTIVE To evaluate the local incidence of orofacial cleft (OFC) encountered in fetal morphology scan and prenatal diagnosis, genetic etiology of fetuses with or without other structural abnormalities, and their pregnancy outcomes. DESIGN Retrospective cohort study. SETTING Two maternal fetal medicine units, tertiary hospitals, Hong Kong. PARTICIPANTS All pregnant women with antenatal diagnosis of fetal OFC between January 2016 and December 2020 (N = 66). RESULTS OFC has an incidence of 0.13% among pregnancies in Hong Kong and 28.8% (19/66) were syndromic cleft that exhibited other fetal structural anomalies. There were 55 cases (84.6%) who opted for invasive prenatal diagnostic testing. Genetic defects were identified in 25.8% (17/66) of this cohort, including 14 pathogenic variants. The detection rate in the syndromic cases is 68.4% (13/19) which was significantly higher than 8.5% (4/47) among non-syndromic cases. Aneuploidies would be the most common cause, accounting for 9.1% (6/66). Chromosomal microarray analysis (CMA) provided an incremental diagnostic yield of 6.1% compared to conventional karyotyping. A total of 29 live births including 3 cases of a variant of uncertain significance and 26 cases without genetic abnormalities detected have continued pregnancy to birth. There were 87.5% (21/24) without detectable pathogenic genetic abnormality reported good long-term outcomes. The chance of OFC fetuses having a good long-term outcome was significantly higher if no genomic variant was detected (P < .001). CONCLUSIONS Invasive prenatal tests with CMA should be offered to pregnancies with OFC regardless of the type. It has provided incremental diagnostic yield over conventional karyotyping and helped in prenatal and genetic counseling. A negative result in non-syndromic OFC favors couples to keep the pregnancy.
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Affiliation(s)
- Yan Yu Li
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Wing Ting Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - Natalie Kwun Long Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
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Poupore NS, Chidarala S, Nguyen SA, Teufel RJ, Patel KG, Pecha PP, Carroll WW. Cleft Lip and/or Palate Repair in Children With Hypopituitarism: Analysis of the Kids' Inpatient Database. Cleft Palate Craniofac J 2024; 61:94-102. [PMID: 35903934 DOI: 10.1177/10556656221117435] [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: 11/16/2022] Open
Abstract
OBJECTIVE Children with hypopituitarism (CwHP) can present with orofacial clefting, frequently in the setting of multiple midline anomalies. Hypopituitarism (HP) can complicate medical and surgical care; the perioperative risk in CwHP during the traditionally lower risk cleft lip and/or palate (CL/P) repair is not well described. The objective of this study is to examine the differences in complications and mortality of CL/P repair in CwHP compared to children without hypopituitarism (CwoHP). DESIGN A retrospective cross-sectional analysis. SETTING The 1997 to 2019 Kids' Inpatient Databases (KID). PATIENTS Children 3 years old and younger who underwent CL/P repair. MAIN OUTCOME MEASURE(S) Complications and mortality. RESULTS A total of 34 106 weighted cases were analyzed, with 86 having HP. CwHP had a longer length of stay (3.0 days [IQR 2.0-10.0] vs 1.0 day [IQR 1.0-2.0], P < .001) and higher rates of complications and mortality (12.8% vs 2.9%, P < .001) compared to CwoHP. Controlling for demographic factors, CwHP had 6.61 higher odds of complications and mortality than CwoHP (95% CI 3.38-12.94, P < .001). CONCLUSIONS CwHP can present with a CL/P and other midline defects that can increase the complexity of their care. These data show a significant increase in length of stay, complications, and mortality in CwHP undergoing CL/P repair. Increased multidisciplinary attention and monitoring may be needed for these children peri- and postoperatively, especially if additional comorbidities are present. Further studies on perioperative management in this population are warranted to reduce morbidity and mortality.
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Affiliation(s)
- Nicolas S Poupore
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Shreya Chidarala
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ronald J Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Krishna G Patel
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - William W Carroll
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Zhao X, Peng X, Wang Z, Zheng X, Wang X, Wang Y, Chen J, Yuan D, Liu Y, Du J. MicroRNAs in Small Extracellular Vesicles from Amniotic Fluid and Maternal Plasma Associated with Fetal Palate Development in Mice. Int J Mol Sci 2023; 24:17173. [PMID: 38139002 PMCID: PMC10743272 DOI: 10.3390/ijms242417173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Cleft palate (CP) is a common congenital birth defect. Cellular and morphological processes change dynamically during palatogenesis, and any disturbance in this process could result in CP. However, the molecular mechanisms steering this fundamental phase remain unclear. One study suggesting a role for miRNAs in palate development via maternal small extracellular vesicles (SEVs) drew our attention to their potential involvement in palatogenesis. In this study, we used an in vitro model to determine how SEVs derived from amniotic fluid (ASVs) and maternal plasma (MSVs) influence the biological behaviors of mouse embryonic palatal mesenchyme (MEPM) cells and medial edge epithelial (MEE) cells; we also compared time-dependent differential expression (DE) miRNAs in ASVs and MSVs with the DE mRNAs in palate tissue from E13.5 to E15.5 to study the dynamic co-regulation of miRNAs and mRNAs during palatogenesis in vivo. Our results demonstrate that some pivotal biological activities, such as MEPM proliferation, migration, osteogenesis, and MEE apoptosis, might be directed, in part, by stage-specific MSVs and ASVs. We further identified interconnected networks and key miRNAs such as miR-744-5p, miR-323-5p, and miR-3102-5p, offering a roadmap for mechanistic investigations and the identification of early CP biomarkers.
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Affiliation(s)
- Xige Zhao
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Xia Peng
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Zhiwei Wang
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Xiaoyu Zheng
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Xiaotong Wang
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Yijia Wang
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Jing Chen
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Dong Yuan
- Department of Geriatric Dentistry, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China;
| | - Ying Liu
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
| | - Juan Du
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China; (X.Z.); (X.P.); (Z.W.); (X.Z.); (X.W.); (Y.W.); (J.C.); (Y.L.)
- Department of Geriatric Dentistry, Capital Medical University School of Stomatology, Tiantan Xili No. 4, Beijing 100050, China;
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Rehman U, Pezas T, Timoney N, Atherton D. CleftED: A National Collaborative Study of Undergraduate Education and Exposure to Cleft lip and Palate Within the United Kingdom. Cleft Palate Craniofac J 2023:10556656231211422. [PMID: 37941383 DOI: 10.1177/10556656231211422] [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: 11/10/2023] Open
Abstract
INTRODUCTION Cleft Lip and/or Palate (CLP) are the most common congenital orofacial anomalies. Those involved in CLP care may extend beyond the core members of the Cleft multidisciplinary team (MDT) with a variety of medical healthcare professionals destined to contribute to the management of CLP patients at some point during their respective careers. Therefore, it seems essential that a basic understanding of CLP, CLP-associated problems, and potential avenues for direct or indirect involvement in CLP care be introduced at undergraduate level. AIMS To investigate penultimate and final year undergraduate medical student CLP knowledge and exposure obtained whilst at medical school. METHODOLOGY An online questionnaire was distributed to penultimate and final year medical students throughout the UK. RESULTS A total of 3102 responses were received from 35 medical schools. 44.3% (n = 1374) of respondents had no exposure to CLP teaching up until their current year of education. 61.3% (n = 1903) of respondents had never been involved in the care of a CLP patient. 53.6% (n = 1662) of respondents were not confident in their current knowledge of CLP. 78.5% (n = 2257) of respondents indicated a desire to be involved in the care of CLP patients in their future career. CONCLUSION More than half of the medical student survey respondents were not confident in their current knowledge of CLP and had limited involvement in CLP care. This may translate to a delay in diagnosis when students qualify. Improving CLP education and exposure during undergraduate training can help achieve national CLP standards for early diagnosis.
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Affiliation(s)
- Umar Rehman
- Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Theodore Pezas
- South Thames Cleft Service, Evelina London Children's Hospital, London, UK
| | - Norma Timoney
- South Thames Cleft Service, Evelina London Children's Hospital, London, UK
| | - Duncan Atherton
- South Thames Cleft Service, Evelina London Children's Hospital, London, UK
- School of Medicine, Kings College London, London, UK
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Poupore NS, Jungbauer WN, Smaily H, Carroll WW, Pecha PP. Impact of Syndromes on Sleep-Disordered Breathing in Children After Cleft Palate Repair. Cleft Palate Craniofac J 2023; 60:1419-1425. [PMID: 35642260 PMCID: PMC10083050 DOI: 10.1177/10556656221105203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Prior research suggests that children with cleft palate (CP) are at increased risk of obstructive sleep-disordered breathing (SDB). However, few studies differentiate the effects of CP repair on SDB based on syndrome status. The goal of this study was to evaluate differences in SDB after palatoplasty among children with nonsyndromic CP, syndromic CP, and isolated Robin sequence (RS). DESIGN Retrospective chart review. SETTING Tertiary academic children's hospital. PATIENTS/PARTICIPANTS A total of 145 children who underwent primary CP repair from 2014 to 2021. MAIN OUTCOME MEASURE Post-palatoplasty SDB is defined as parent-reported symptoms and/or evidence of obstructive sleep apnea (OSA). RESULTS Median age at palatoplasty was 11.1 [IQR 10.2-13.6] months. Most patients (61.4%) had nonsyndromic CP, 26.9% had a syndrome, and 11.7% had RS. Children with syndromic CP and RS had more post-palatoplasty SDB symptoms (56.4% vs 58.8% vs 30.3%, P = .006) and higher rates of OSA (25.6% vs 29.4% vs 5.6%, P = .001) compared to children with nonsyndromic CP after palatoplasty. Children with syndromic CP and RS had nearly 3 to 4 higher odds of post-palatoplasty SDB than children with nonsyndromic CP (adjusted odds ratio [aOR] 2.88, 95% CI 1.29-6.47, P = .010; aOR 3.73, 95% CI 1.19-11.70, P = .024). CONCLUSION This study showed that children with CP experience higher rates of SDB after palatoplasty than the general pediatric population. Within the cohort, children with syndromic CP and isolated RS were more likely to have obstructive sleep disorders than nonsyndromic children after palatoplasty. Clinicians should counsel caregivers accordingly and closely monitor these groups for SDB after palate repair.
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Affiliation(s)
| | | | - Hussein Smaily
- Medical University of South Carolina, Charleston, SC, USA
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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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Gee S, Ezzeldin M, Curtis J, Clark VJ, Smallridge J, Collard M. Associated medical conditions among 10-year-old children with oral clefts - a retrospective review across three cleft centres: Part 2. Br Dent J 2023; 234:931-936. [PMID: 37349449 PMCID: PMC10287554 DOI: 10.1038/s41415-023-5975-6] [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: 09/21/2022] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 06/24/2023]
Abstract
Introduction In many cases, children with oral clefts present with accompanying medical conditions. These associated conditions can add complexity to the patient's dental management, both in terms of their treatment need and risk. Recognition and careful consideration of associated medical conditions is therefore crucial in providing safe and effective care for these patients.Aim This paper is the second in a two-part three-centre series. It investigates the prevalence of medical conditions affecting cleft lip and/or palate patients attending three cleft units within the UK.Method Retrospective review was undertaken within three cleft units: South Wales (SW), Cleft NET East (CNE) and West Midlands (WM). This was completed via assessment of the 10-year audit record appointment clinical notes for the year 2016/2017.Results In total, 144 cases were reviewed (SW = 42; CNE = 52; WM = 50). Of these, 38.9% of patients (n = 56) had associated medical conditions recorded.Discussion The review highlights the variety and impact of medical conditions affecting UK cleft patients providing insight into the consequent complexity of their dental care.Conclusion An awareness of cleft lip and/or palate patients' associated medical conditions is important for all health care professionals involved in their care. Indeed, understanding of the patient's medical needs by multidisciplinary cleft teams is essential for effective planning and completion of holistic care. Involvement of specialists in paediatric dentistry sharing care with general dental practitioners is vital in providing appropriate oral health care and preventive support.
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Affiliation(s)
- Samantha Gee
- Specialty Registrar and Honorary Clinical Teacher in Paediatric Dentistry, University Dental Hospital and School, Cardiff, United Kingdom.
| | - Maryam Ezzeldin
- Specialist and Honorary Clinical Teacher in Paediatric Dentistry, University Dental Hospital and School, Cardiff, United Kingdom
| | - Jacob Curtis
- Post Certificate of Completion of Training in Orthodontics, Morriston Hospital, Swansea, United Kingdom
| | - Victoria J Clark
- Consultant in Paediatric Dentistry, Birmingham Children´s Hospital, United Kingdom
| | - Jacqueline Smallridge
- Consultant in Paediatric Dentistry, CleftNetEast, Cambridge University Hospitals, United Kingdom
| | - Mechelle Collard
- Consultant in Paediatric Dentistry, Morriston Hospital, Swansea, UK; Consultant and Honorary Senior Lecturer in Paediatric Dentistry, University Dental Hospital and School, Cardiff, United Kingdom
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Cabanas CC, Falconi S, Jones H, Subhani M, Adesanya OA. Cleft Palate in a Newborn With Trisomy 21: A Case Report. Cureus 2023; 15:e39107. [PMID: 37332434 PMCID: PMC10270723 DOI: 10.7759/cureus.39107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Trisomy 21, or Down syndrome (DS), is neonates' most common chromosomal abnormality. In addition, children born with DS have an increased risk of congenital anomalies such as congenital heart defects, gastrointestinal abnormalities, and, rarely, cleft palate. Cleft lip and palate are among the most common congenital anomalies associated with many congenital syndromes; however, Trisomy 21 is the least common congenital anomaly associated with orofacial clefts. We present a case of cleft palate, duodenal stenosis, persistent pulmonary hypertension of the newborn, patent ductus arteriosus, and atrial septal defect in a newborn with classical clinical features of Down syndrome. This report discusses the uncommon presentation of trisomy 21 and concomitant cleft palate in a neonate, including its recognition and treatment, as no standard of care treatment exists.
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Affiliation(s)
| | - Sirin Falconi
- General Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Hannah Jones
- General Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Muhammad Subhani
- Neonatology, Texas Tech University Health Sciences Center, Amarillo, USA
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11
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Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients-A Comprehensive Review. J Pers Med 2022; 12:jpm12122089. [PMID: 36556309 PMCID: PMC9783897 DOI: 10.3390/jpm12122089] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cleft lip and cleft palate has one of the highest incidences in the malformations of the oral cavity, that varies between populations. The background underlying the issue of cleft lip and palate is multifactorial and greatly depends on the genetic factors and environmental factors. The aim of this nonsystematic narrative review is to present the cleft palate and or lip pediatric population as target for interdisciplinary treatment. The purpose of this narrative review is to sum up the modern knowledge on the treatment of patients with clefts, as well as to highlight the importance of the great need for cooperation between different dental specialists along with medical professionals such as oral surgeons, prosthodontists, orthodontists along with medical professions such as pediatricians, speech therapists and phoniatrics, and laryngologist.
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12
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Chen J, Yao Y, Wang Y, Wang X, Peng X, Li T, Liu Y, Du J. Autophagy triggered by the ROS/ERK signaling pathway protects mouse embryonic palatal cells from apoptosis induced by nicotine. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:81909-81922. [PMID: 35739442 DOI: 10.1007/s11356-022-21496-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
Maternal cigarette smoking during pregnancy is a known high-risk factor for having a child with a cleft lip and/or palate (CLP), a common congenital malformation. Nicotine is the major teratogen component of cigarettes and e-cigarettes, and nicotine plays an important role in the development of CLP. However, the mechanism underlying nicotine's effect on CLP remains unclear. Here, we aimed to determine the role and molecular mechanisms of nicotine-induced autophagy, an important process involved in regulating the cellular stress response in mouse embryonic palatal cells (MEPCs). First, we found that nicotine promoted MEPCs proliferation and inhibited their apoptosis from 0 to 12 h. After 12 h, the proliferation was inhibited, and apoptosis was promoted. The migration of MEPCs was also inhibited by nicotine. Simultaneously, long-term nicotine stimulation inhibited the osteogenic differentiation of MEPCs. We then found that nicotine significantly increased autophagy flux in MEPCs at 12 h by increasing the expression of microtubule-associated protein light chain 3 (LC3) and reducing P62 expression levels. After nicotine exposure, intracellular reactive oxygen species (ROS) and extracellular signal-regulated kinase-1/2 (ERK1/2) expression significantly increased, and the expression of ERK1/2 was reversed by the ROS scavenging agent N-acetylcysteine (NAC). Moreover, the autophagy induced by nicotine was reversed by SCH772984, a specific inhibitor of ERK1/2, and the autophagy inhibitor chloroquine (CQ). These results suggest that in the early stage of nicotine exposure, MEPCs may trigger autophagy through the ROS/ERK1/2 signaling pathway to avoid cell damage caused by nicotine.
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Affiliation(s)
- Jing Chen
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Yaxia Yao
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Yijia Wang
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Xiaotong Wang
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Xia Peng
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Tianli Li
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Ying Liu
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China
| | - Juan Du
- Laboratory of Orofacial Development, Laboratory of Molecular Signaling and Stem Cells Therapy, Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, 100050, China.
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13
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Zaza P, Indrio F, Fracchiolla A, Rinaldi M, Meliota G, Salatto A, Bonacaro A, Maffei G. Cleft Palate and Aortic Dilatation as Clues for Loeys–Dietz Syndrome. CHILDREN 2022; 9:children9091290. [PMID: 36138598 PMCID: PMC9497579 DOI: 10.3390/children9091290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022]
Abstract
Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1–LDS6, respectively). Delay in diagnosis of Loeys–Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation.
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Affiliation(s)
- Pierluigi Zaza
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Flavia Indrio
- Department of Medical and Surgical Science Pediatric Section, University of Foggia, 71100 Foggia, Italy
- Correspondence:
| | - Annalisa Fracchiolla
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Matteo Rinaldi
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
| | - Giovanni Meliota
- Ospedale Giovanni XXIII U.O. Cardiologia Pediatrica, 70124 Bari, Italy
| | - Alessia Salatto
- DAI Materno-Infantile, Azienda Ospedaliera-Universitaria Federico II di Napoli, 80100 Napoli, Italy
| | - Antonio Bonacaro
- School of Health and Sports Sciences, University of Suffolk, Ipswich IP4 1QJ, UK
| | - Gianfranco Maffei
- Ospedali Riuniti Foggia Italy-U.O.C. Neonatologia e Terapia Intensiva Neonatale, 71100 Foggia, Italy
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14
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Li MJ, Shi JY, Zhang BH, Chen QM, Shi B, Jia ZL. Targeted re-sequencing on 1p22 among non-syndromic orofacial clefts from Han Chinese population. Front Genet 2022; 13:947126. [PMID: 36061182 PMCID: PMC9428125 DOI: 10.3389/fgene.2022.947126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Rs560426 at 1p22 was proved to be associated with NSCL/P (non-syndromic cleft lip with or without the palate) in several populations, including Han Chinese population. Here, we conducted a deep sequencing around rs560426 to locate more susceptibility variants in this region. In total, 2,293 NSCL/P cases and 3,235 normal controls were recruited. After sequencing, association analysis was performed. Western blot, RT-qPCR, HE, immunofluorescence staining, and RNA sequencing were conducted for functional analyses of the selected variants. Association analysis indicated that rs77179923 was the only SNP associated with NSCLP specifically (p = 4.70E-04, OR = 1.84), and rs12071152 was uniquely associated with LCLO (p = 4.00E-04, OR = 1.30, 95%CI: 1.12–1.51). Moreover, de novo harmful rare variant NM_004815.3, NP_004806.3; c.1652G>C, p.R551T in ARHGAP29 resulted in a decreased expression level of ARHGAP29, which in turn affected NSCL/P-related biological processes; however, no overt cleft palate (CP) phenotype was observed. In conclusion, rs12071152 was a new susceptible variant, which is specifically associated with LCLO among the Han Chinese population. Allele A of it could increase the risk of having a cleft baby. Rs77179923 and rare variant NM_004815.3, NP_004806.3; c.1652G>C, p.R551T at 1p22 were both associated with NSCLP among the Han Chinese population. However, this missense variation contributes to no overt CP phenotype due to dosage insufficiency or compensation from other genes.
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Affiliation(s)
- Mu-Jia Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jia-Yu Shi
- Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bi-He Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qian-Ming Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhong-Lin Jia
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Zhong-Lin Jia,
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15
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Saikia A, Muthu M, Orenuga OO, Mossey P, Ousehal L, Yan S, Campodonico M, England R, Taylor S, Sheeran P. Systematic Review of Clinical Practice Guidelines for Oral Health in Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 59:800-814. [PMID: 34159833 PMCID: PMC9121521 DOI: 10.1177/10556656211025189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) exist to present recommendations and policies aimed at optimizing the oral health of children and adolescents born with cleft lip and/or palate. The aim of this review is to identify and assess the scope, quality, adequacy, and consistency of CPGs related to oral health in children and adolescents with clefts, along with reporting any differences and shortcomings. METHODS A systematic review of the literature of CPGs following Preferred Reporting Items for Systematic Reviews guidelines was conducted. Assessment of selected CPGs was performed using the Appraisal of Guidelines for Research & Evaluation II methodological quality instrument. RESULTS Only 7 CPGs fulfilled the criteria. Of these, 4 were from the American Cleft Palate-Craniofacial Association, and 1 each from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and the American Academy of Pediatric Dentistry. The lowest overall mean scores were in the domain "Rigor of Development" (mean 29.58%, SD 17.11), revealing lower quality in methodology of the guideline. The domain "Clarity of Presentation" (mean 73.80%, SD 7.87) revealed the best score. CONCLUSIONS Our review results reveal a lack of integrated high-quality CPGs that can be used as universal guidelines by health workers in a range of disciplines for improving oral health in children and adolescents with cleft problems.
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Affiliation(s)
- Ankita Saikia
- Consulting Pediatric Dental Surgeon, Pedo Planet Children Dental
Centre, Porur, Chennai, Tamilnadu, India
| | - M.S. Muthu
- Centre for Early Childhood Caries Research (CECCRe), Faculty of
Dental Sciences, Department of Pediatric Dentistry, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai, Tamilnadu, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman
University, United Arab Emirates
| | - Omolola O. Orenuga
- Department of Child Dental Health, College of Medicine University of
Lagos, University Teaching Hospital, Lagos, Nigeria
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, United
Kingdom
| | - Lahcen Ousehal
- Department of Orthodontics , University of Casablanca, Morocco
| | - Si Yan
- Department of Preventive Dentistry, Peking University, Beijing,
People’s Republic of China
| | | | | | - Sean Taylor
- FDI World Dental Federation, Geneva, Switzerland
| | - Pamela Sheeran
- Strategic Programs and Partnerships, Comprehensive Cleft Care,
Smile Train, NY, USA
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16
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Lentge K, Lentge F, Zeller AN, Gellrich NC, Tavassol F, Korn P, Spalthoff S. Cleft lip and palate: the psychological burden of affected parents during the first three years of their children's lives. Int J Oral Maxillofac Surg 2022; 51:1462-1468. [PMID: 35513959 DOI: 10.1016/j.ijom.2022.04.003] [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: 05/12/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
The surgical treatment of cleft lip and palate (CLP) has been well described in the literature. Nevertheless, little is known about the psychological burden of affected parents. The aim of this study was to investigate the psychological burden in parents of children with CLP within the first 3 years of the children's lives. A standardized questionnaire (Parenting Stress Index, PSI) was administered to 33 parents of children with CLP to evaluate their psychological burden. The corresponding interview was conducted independent of any operative procedure during the yearly routine CLP consultation. Each participant's stress profile was assessed and compared with the average values of parents with non-cleft children. Psychological stress was substantially increased in all participants when compared to the parents of healthy children. This result was highly significant (P < 0.001). Parent depression (P < 0.001) and child-related requirements (P < 0.001) were the most critical subscales in the stress profile. Overall, the child-related burden was greater than the parent-related burden. These results indicate that parents of children with CLP have a higher level of psychological stress than parents of non-cleft children. This psychological stress might be reduced if addressed by specialist clinical psychologists in cleft-treating centres.
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Affiliation(s)
- K Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - F Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - A-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - F Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - P Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - S Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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17
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Jungbauer WN, Poupore NS, Nguyen SA, Carroll WW, Pecha PP. Obstructive sleep apnea in children with non-syndromic cleft palate: a systematic review. J Clin Sleep Med 2022; 18:2063-2068. [PMID: 35459445 PMCID: PMC9340587 DOI: 10.5664/jcsm.10020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To characterize obstructive sleep apnea (OSA) in children with non-syndromic cleft palate based on polysomnographic parameters relative to primary palatoplasty. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched: PubMed, Scopus, CINAHL, and Cochrane. Studies were only considered for inclusion if they examined exclusively non-syndromic cleft palate patients and reported polysomnogram data. RESULTS Seven studies met inclusion criteria, providing information on a total of 151 patients with a weighted mean age of 5.2 ± 5.0 years old (range 0.1- 12 years). Five studies presented data from either the pre- or post-operative period. Two studies investigated both pre- and post-palatoplasty polysomnogram data, and neither observed a significant change in apnea hypopnea index (AHI) values following surgery (mean pre-operative AHI of 2.7, mean improvement of 0.6 events/hour). The entire cohort had a pre-palatoplasty weighted mean AHI of 11.4 (range 1.5 -16.1) and post-palatoplasty AHI of 1.5 (range 0.2 - 5.2). Interpretation of polysomnographic data was limited by heterogeneity; however, the AHI values of children with non-syndromic cleft palate largely demonstrated mild to moderate OSA following palatoplasty. CONCLUSIONS The full effect of cleft palate repair on OSA in children with non-syndromic cleft palate remains understudied. While published data are heterogenous, few studies support the worsening of obstructive AHI after palatoplasty in children with non-syndromic cleft palate. Further studies with standardized polysomnographic parameters are needed to provide guidance for management of this population.
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Affiliation(s)
- W Nicholas Jungbauer
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC
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18
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Borte M, Raffac S, Hrubiško M, Jahnz-Rozyk K, Garcia E, McCoy B, Chavan S, Nagy A, Yel L. Long-term safety of facilitated subcutaneous immunoglobulin treatment in pregnant women with primary immunodeficiency diseases: results from a registry study. Immunotherapy 2022; 14:609-616. [PMID: 35443783 DOI: 10.2217/imt-2021-0336] [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: 11/21/2022] Open
Abstract
Aim: Clinical outcomes of women who become pregnant during/after facilitated subcutaneous immunoglobulin (fSCIG) treatment are not well characterized. Materials & methods: This noninterventional, prospective, open-label, post authorization, pregnancy registry study assessed safety outcomes in mothers with primary immunodeficiency diseases who had ever received fSCIG before/during pregnancy and their infants (n = 7). Enrolled women received alternative treatment (arm 1: n = 2) or continued fSCIG (arm 2: n = 7) during pregnancy. Results: No treatment-related adverse events (AEs)/serious AEs (SAEs) were reported. 13 AEs occurred in mothers, including two SAEs (thrombocytopenia, pre-eclampsia; arm 2). A total of 17 AEs occurred in infants, including two SAEs (cleft lip, talipes calcaneovalgus; arm 2) with normal growth/development. Conclusion: Findings provide limited but useful safety data regarding women who received fSCIG before/during pregnancy and the growth/development of their infants. Clinical Trial registration: NCT02556775 (ClinicalTrials.gov); EUPAS5798.
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Affiliation(s)
- Michael Borte
- Klinik für Kinder- und Jugendmedizin, Klinikum St Georg GmbH, Leipzig, Germany
| | - Stefan Raffac
- Clinic of Clinical Immunology and Allergology, RAFMED s.r.o, Košice, Slovak Republic
| | - Martin Hrubiško
- Department of Clinical Allergology and Immunology, Oncology Institute of St. Elisabeth, Bratislava, Slovak Republic
| | - Karina Jahnz-Rozyk
- Department of Internal Medicine, Pneumology, Allergology and Clinical Immunology, Military Institute of Medicine, Warsaw, Poland
| | - Enrique Garcia
- Plasma-Derived Therapies BU, Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
| | - Barbara McCoy
- Plasma-Derived Therapies BU, Baxalta Innovations GmbH, a Takeda company, Vienna, Austria
| | - Shailesh Chavan
- Plasma-Derived Therapies BU, Baxalta Innovations GmbH, a Takeda company, Vienna, Austria
| | - Andras Nagy
- Plasma-Derived Therapies BU, Baxalta Innovations GmbH, a Takeda company, Vienna, Austria
| | - Leman Yel
- Plasma-Derived Therapies BU, Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
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19
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Stowe G, Schleif EP, Perry JL, Briley PM. Impact of Insurance Status on Initiation of Breast Milk Feeding Among Infants With CL ± P. Cleft Palate Craniofac J 2022:10556656221087553. [PMID: 35306864 DOI: 10.1177/10556656221087553] [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: 11/15/2022] Open
Abstract
To evaluate rates of breast milk feeding among infants with cleft lip with or without cleft palate (CL ± P) enrolled in Medicaid compared to Private Insurance/Self-Pay. This was a population-based retrospective cohort study. The 2018 US National Vital Statistics System-Natality component (NVSS-N) was used to examine nationwide birth certificate data. Infants with cleft lip with or without cleft palate and either Medicaid or Private Insurance/Self-Pay were included. Breast milk feeding rates among infants with CL ± P, as a function of insurance status. Chi-square tests of independence revealed that of 896 infants with CL ± P and insured by Medicaid, 527 (58.8%) were breast milk fed at discharge. Of 865 infants with CL ± P and insured by Private Insurance/Self-Pay, 621 (71.8%) were breast milk fed at discharge. Using logistic regression models and controlling for baseline demographic differences, results indicated that infants with CL ± P in the Medicaid group had reduced odds of breast milk feeding compared to the Private Insurance/Self-Pay group (OR = 0.08; 95% CI 0.56, 0.96). Breast milk support services are often necessary for the initiation of breast milk feeding among infants with CL ± P. However, these resources are likely not as readily available for those enrolled in Medicaid. These results suggest that infants with CL ± P, enrolled in Medicaid, may experience reduced breast milk feeding rates due to limited resources to initiate breast milk feeding. Factors that may promote breast milk feeding among this population are discussed.
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Affiliation(s)
- Gabrielle Stowe
- Department of Communication Sciences & Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| | - Eshan P Schleif
- Department of Communication Sciences & Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| | - Jamie L Perry
- Department of Communication Sciences & Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
| | - Patrick M Briley
- Department of Communication Sciences & Disorders, College of Allied Health Sciences, 3627East Carolina University, Greenville, NC, USA
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20
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Impact of Cleft Palate Anastomosis in Cleft Lip and Palate Patients with Coexisting Cleft Lip Anastomosis Scar Based on Cephalometric Measurements. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
(1) Background: This article focuses on examining components affecting the overbite, overjet, and the effect of palate surgery on craniofacial morphology with a concomitant cleft lip fusion scar, and a comparison of patients who had only a cleft lip fusion scar. Patients with unilateral cleft lip (UCL) and patients with unilateral cleft lip and palate (UCLP) were included in the study. We aimed to find if cephalometric parameters were significantly different in these groups. (2) Material and methods: The study group consisted of a lateral cranial radiograph of patients with UCLP (n = 30) and UCL (n = 30). Cephalometric radiographs were saved electronically, and cephalometric analysis was performed using a computer program. (3) Results: We observed that a statistically significant higher degree of maxillary prognathism occurred in the UCL than in the UCLP. We observed the anterior position of the upper lip in relation to E-line in patients with cleft lip. (4) Conclusions: The results present the effect of cleft palate surgery on further forward growth of the maxilla. There was a decreased ANB angle present in the skeletal class II in patients with UCL and UCLP. The SNB angle was not increased, and the reverse overjet was due to the rectroclination of the upper incisors and protruded lower incisors.
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21
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Wu Q, Li Z, Zhang Y, Peng X, Zhou X. Dental caries and periodontitis risk factors in cleft lip and palate patients. Front Pediatr 2022; 10:1092809. [PMID: 36683789 PMCID: PMC9846248 DOI: 10.3389/fped.2022.1092809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Cleft lip and palate (CLP) is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. Risk factors contributing to CLP may conclude as genetic factors and environmental factors. The anatomical and morphological abnormalities related to CLP are favorable for dental plaque accumulation on the tooth surface. Therefore, patients with CLP undergo poorer oral hygiene and higher susceptibility to dental caries and periodontitis. In this review, we aim to conclude and update probable causes underlying the association between CLP and poor oral health and provide novel ideas of targeted early prevention for such oral diseases.
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Affiliation(s)
- Qinrui Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhengyi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yixin Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xian Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Chhodon L, Prasad V, Aravindhan A, Zaidi SJA. Prosthetic rehabilitation of patients with cleft lip and palate. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2022. [DOI: 10.4103/jclpca.jclpca_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Clinical Practice Guidelines for the Management of Patients With Cleft Lip and Palate: A Systematic Quality Appraisal Using the Appraisal of Guidelines for Research and Evaluation II Instrument. J Craniofac Surg 2021; 33:449-452. [PMID: 34545056 DOI: 10.1097/scs.0000000000008155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
ABSTRACT Patients with cleft lip and/or palate require complex and longitudinal care by a multidisciplinary cleft team. Unfortunately, delivery of cleft care is often fragmented, and care practices can vary significantly. Multiple clinical practice guidelines (CPGs) have been proposed to provide a standardized framework for cleft care delivery. As CPGs have gained popularity, there has been increasing demand to maintain the quality of existing guidelines. A comprehensive search of EMBASE, MEDLINE via PubMed, Scopus, Cochrane and grey literature sources published from January 1, 1990 to December 31, 2020 was conducted to identify CPGs for the care of cleft patients. The Appraisal of Guidelines for Research and Evaluation, 2nd edition II tool was used to assess the quality of selected CPGs. Intraclass coefficients were calculated to assess agreement among appraisers. Eleven guidelines were identified for study inclusion. One guideline was classified as "high" quality by Appraisal of Guidelines for Research and Evaluation II criteria, and the remaining guidelines were classified as "average" or "low" quality. The "Clarity of Presentation" domain achieved the highest mean score (76.9% ± 11.7%) across CPGs, whereas the "Rigor of Development" domain scored the lowest (35.6% ± 21.2%). Intraclass coefficients analysis reflected very good inter-rater reliability across all domains (0.853-0.987). These findings highlight significant variability in the quality of existing CPGs for the global management of patients with cleft lip and/or palate. The "Rigor of Development" domain reflects the greatest opportunity for improvement. Given these findings, future guidelines may prioritize incorporating a systematic review of existing evidence into recommendations.
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Leone TA, Abreu WJ. The Term Newborn: Delivery Room Triage and Transitions of Care. Clin Perinatol 2021; 48:431-445. [PMID: 34353574 DOI: 10.1016/j.clp.2021.05.001] [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: 11/29/2022]
Abstract
Term newborn infants without significant medical problems usually transition from fetal to newborn life without medical assistance. Infants requiring therapy often need care in a neonatal intensive care unit as opposed to a well-baby unit. Infants with unclear physiologic status or disease that may require therapies in the immediate newborn period may benefit from a period of observation with close monitoring before admission to a well-baby unit. Whenever possible, providing care for a newborn infant in an area that provides care for the newborn and mother together in the same room facilitates adaptation to normal breastfeeding and family bonding.
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Affiliation(s)
- Tina A Leone
- Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH 17-302, New York, NY 10032, USA.
| | - Wanda J Abreu
- Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, VC-402A, New York, NY 10032, USA
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Findlen UM, Grischkan J, Alston S, Durinka L, Baylis A. Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative. Cleft Palate Craniofac J 2021; 59:961-969. [PMID: 34235991 DOI: 10.1177/10556656211029526] [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: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate. DESIGN Prospective, multidisciplinary quality improvement initiative. SETTING Tertiary pediatric hospital. PATIENTS, PARTICIPANTS Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205). INTERVENTIONS A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication. MAIN OUTCOME MEASURE(S) Completion of recommended audiologic assessment at 5 separate care milestones. RESULTS After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes. CONCLUSIONS Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.
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Affiliation(s)
- Ursula M Findlen
- Audiology Department, Nationwide Children's Hospital, OH, USA.,Department of Otolaryngology, Head & Neck Surgery, The Ohio State University Wexner Medical Center, OH, USA
| | - Jonathan Grischkan
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University Wexner Medical Center, OH, USA.,Department of Pediatric Otolaryngology, Nationwide Children's Hospital, OH, USA
| | - Sandra Alston
- Audiology Department, Nationwide Children's Hospital, OH, USA
| | - Lauren Durinka
- Audiology Department, Nationwide Children's Hospital, OH, USA
| | - Adriane Baylis
- Department of Plastic Surgery, Nationwide Children's Hospital, OH, USA
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Li P. 2020 edition of the Rourke Baby Record: What is new in preventive care of children up to 5 years of age? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:488-498. [PMID: 34261708 PMCID: PMC8279664 DOI: 10.46747/cfp.6707488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To update primary care providers practising well-child and well-baby clinical care on the evidence that contributed to the recommendations of the 2020 edition of the Rourke Baby Record (RBR). QUALITY OF EVIDENCE Pediatric preventive care literature was searched from June 2016 to May 2019, primary research studies were reviewed and critically appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and recommendations were updated where there was support from the literature. MAIN MESSAGE Notable changes in the 2020 edition of the RBR include the recommendations to limit or avoid consumption of highly processed foods high in dietary sodium, to ensure safe sleep (healthy infants should sleep on their backs and on a firm surface for every sleep, and should sleep in a crib, cradle, or bassinette in the parents' room for the first 6 months of life), to not swaddle infants after they attempt to roll, to inquire about food insecurity, to encourage parents to read and sing to infants and children, to limit screen time for children younger than 2 years of age (although it is accepted for videocalling), to educate parents on risks and harms associated with e-cigarettes and cannabis, to avoid pesticide use, to wash all fruits and vegetables that cannot be peeled, to be aware of the new Canadian Caries Risk Assessment Tool, to note new red flags for cerebral palsy and neurodevelopmental problems, and to pay attention to updated high-risk groups for lead and anemia screening. CONCLUSION The RBR endeavours to guide clinicians in providing evidence-informed primary care to Canadian children. The revisions are rigorously considered and are based on appraisal of a growing, albeit still limited, evidence base for pediatric preventive care.
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Affiliation(s)
- Patricia Li
- Clinician-Scientist in the Centre for Outcomes Research and Evaluation at the McGill University Health Centre Research Institute in Montreal, Que, Associate Professor in the Department of Pediatrics at McGill University, and a general pediatrician at the Montreal Children’s Hospital
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Rodrigues R, Chung AP, Mortensen MS, Fernandes MH, Monteiro AB, Furfuro R, Silva CC, Manso MC, Sørensen SJ, Morais PV. Temporal oral microbiome changes with brushing in children with cleft lip and palate. Heliyon 2021; 7:e06513. [PMID: 33817376 PMCID: PMC8005767 DOI: 10.1016/j.heliyon.2021.e06513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/21/2020] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
This cohort study aimed to characterize the oral microbiome of children with CLP, from two different age groups, and evaluate the effect of supervised or unsupervised toothbrushing on the microbiome of the cleft over time. Swab samples were collected from the cleft area at three different time points (A; no brushing, B; after 15 days and C; after 30 days) and were analyzed using next-generation sequencing to determine the microbial composition and diversity in these time points. Overall, brushing significantly decreased the abundance of the genera Alloprevotella and Leptotrichia in the two age groups examined, and for Alloprevotella this decrease was more evident for children (2-6 years old). In the preteen group (7-12 years old), a significant relative increase of the genus Rothia was observed after brushing. In this study, the systematic brushing over a period of thirty days also resulted in differences at the intra-individual bacterial richness.
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Affiliation(s)
- Rita Rodrigues
- Faculty of Dentistry, University of Porto, R. Dr. Manuel Pereira da Silva, 93, 4200-393, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Praça 9 de Abril, 349, 4249-004, Porto, Portugal
| | - Ana P. Chung
- University of Coimbra, Centre for Mechanical Engineering, Materials and Processes, Department of Life Sciences, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal
| | - Martin S. Mortensen
- Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, DK-2200, Copenhagen N, Denmark
| | - Maria H. Fernandes
- Associated Laboratory for Green Chemistry (LAQV/REQUIMTE), University of Porto, 4051-401, Porto, Portugal
| | | | - Rowney Furfuro
- Compor Clinic, R. Aval de Cima 34, 4200-105, Porto, Portugal
| | - Cátia C. Silva
- Faculty of Health Sciences, University Fernando Pessoa, Praça 9 de Abril, 349, 4249-004, Porto, Portugal
| | - Maria C. Manso
- Associated Laboratory for Green Chemistry (LAQV/REQUIMTE), University of Porto, 4051-401, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Fernando Pessoa Energy, Environment and Health Research Unit (FP-ENAS), Praça de 9 de Abril, 349, 4249-004, Porto, Portugal
| | - Søren J. Sørensen
- Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, DK-2200, Copenhagen N, Denmark
| | - Paula V. Morais
- University of Coimbra, Centre for Mechanical Engineering, Materials and Processes, Department of Life Sciences, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal
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Carvalho NO, Matos MFS, Belchior IFC, Araújo MB, Rocha CT, Neves BG. Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Cleft lip and palate are types of craniofacial birth defects that affect thousands of children worldwide each year. These conditions are sensitive topics of conversations, often affected by the stigma of physical birth deformities and cultural myths. This article reviews the pathophysiology of cleft lip and palate, and describes the traditional management of patients with oral-facial clefts, including the extensive supportive care and an interprofessional team or cleft team approach that extends beyond the surgical correction.
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Affiliation(s)
- Corinne I Alois
- Corinne I. Alois is an assistant professor-industry professional in the Department of Clinical Health Professions at St. John's University College of Pharmacy and Health Sciences in Queens, N.Y., and an adjunct faculty member in the PA program at Pace University-Lenox Hill in New York City, N.Y. Rachel A. Ruotolo is a partner in Long Island Plastic Surgical Group in Garden City, N.Y. The authors have disclosed no potential conflicts of interest, financial or otherwise
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30
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Problemas de Salud Mental en Niños con Fisura Labiopalatina. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2020. [DOI: 10.33881/2027-1786.rip.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Los niños que padecen enfermedades genéticas son una población vulnerable para desarrollar problemas de salud mental. La fisura labiopalatina (FLAP) es una anomalía congénita de tipo estructural. Objetivo: Estudiar el impacto a nivel familiar del diagnóstico de FLAP. Metodología: Alcance descriptivo, de diseño mixto y corte transversal. Se construyó un cuestionario autoadministrado compuesto por un consentimiento informado, un cuestionario de datos sociodemográficos, el Child Behavior CheckList y preguntas abiertas. El muestreo fue intencional y la muestra fue de 42 casos. Resultados: El diagnóstico de una fisura labio palatina es una experiencia difícil en los padres, quienes viven este momento de manera negativa, con tristeza y miedo. Los niños en edad preescolar con diagnóstico de fisura labiopalatina son una población en riesgo de desarrollar trastornos psicopatológicos, mayormente de tipo externalizantes.
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Pfeifauf KD, Snyder-Warwick AK, Patel KB. Proposed Federal Bill to Mandate Insurance Coverage for Children With Congenital Anomalies. Cleft Palate Craniofac J 2020; 57:770-772. [PMID: 32253925 DOI: 10.1177/1055665620913024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Ensuring Lasting Smiles Act was reintroduced in United States Congress in March 2019. If enacted, the bill will substantially limit private insurers' ability to deny coverage for the medically necessary treatment of congenital anomalies, including cleft palate and craniofacial anomalies. Coverage denials are currently a barrier to care for these individuals, especially for patients residing in states lacking coverage mandates. The purpose of this article is to describe the issues underlying the proposed federal legislation and provide a policy discussion to better inform cleft and craniofacial providers about pending legislation relevant to their practice.
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Affiliation(s)
- Kristin D Pfeifauf
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
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32
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Min JG, Khosla RK, Curtin C. Descriptive Overview of Primary Cleft Palate Surgeries in the Low- and Middle-Income Countries. Cleft Palate Craniofac J 2020; 57:984-989. [PMID: 32207319 DOI: 10.1177/1055665620911556] [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: 11/16/2022] Open
Abstract
OBJECTIVE To increase access to high-quality and multiregional databases in global epidemiology of cleft surgeries through partnership with an NGO. DESIGN The study retrospectively analyzes 34 801 primary palate surgeries in 70+ countries from the 2016 electronic health records of an non-governmental organization (NGO). The study also utilizes the Kids' Inpatient Database to compare the epidemiology of primary cleft palate surgeries in the United States. PARTICIPANTS Patient records of those undergoing primary cleft palate surgeries only. MAIN OUTCOME MEASURES Region, age, sex, type of cleft, laterality of cleft. RESULTS Key findings show that average age of those receiving primary cleft palate surgery in the low- and middle-income countries (LMICs) was 1.95 years. The distribution of males and females receiving surgery corresponds to the US national data. More hard cleft palates were on the left side (66.18%) than the right side (33.82%), independent of gender and region. CONCLUSIONS Databases from an established NGO can be used to enhance our understanding of the disease characteristics in these regions. By increasing the information available regarding cleft surgeries in the LMIC, we hope to increase awareness of the similarities and differences in surgeries across various regions, as part of an effort to inform the goals set by Global Surgery 2030 initiative by the Lancet Commission.
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Affiliation(s)
- Jung Gi Min
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rohit K Khosla
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine Curtin
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Lewis CW. Teeth: Small but Mighty and Mighty Important. A Comprehensive Review of Children's Dental Health for Primary Care Clinicians. Curr Pediatr Rev 2020; 16:215-231. [PMID: 32108010 DOI: 10.2174/1573396316666200228093248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/12/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022]
Abstract
Healthy teeth allow us to eat and stay well-nourished. Although primary care clinicians receive limited training about teeth, given the common nature of dental problems, it is important that they understand and recognize normal and abnormal dental conditions and can implement primary and secondary prevention of dental conditions in their practice. PubMed has been used to search the scientific literature for evidence on the following topics: normal dental development, dental abnormalities, malocclusion, teething, dental caries and related epidemiology and prevention, fluoride, dental injury and its management and prevention; and identification, prevention and treatment of gingivitis and periodontal disease. Literature review relied on randomized controlled trials, meta-analyses, systematic reviews, and Cochrane reviews when relevant and available. Other sources of evidence included cohort and case-control studies. Consensus statements and expert opinion were used when there was a paucity of high-quality research studies. The literature has been synthesized on these topics to make them relevant to pediatric primary care clinicians, and as available, the strength of evidence has been characterized when making clinical recommendations.
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Affiliation(s)
- Charlotte W Lewis
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital, Seattle, WA, USA
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Zhang Y, Sun X, Han X, Sato H, Hirofuji Y, Masuda K. Protective effect of folic acid on vulnerability to oxidative stress in dental pulp stem cells of deciduous teeth from children with orofacial clefts. Biochem Biophys Res Commun 2019; 516:127-132. [DOI: 10.1016/j.bbrc.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
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Iskandar RPD, Proboningrat A, Fadholly A, Narmada IB, Nidom CA, Sudjarwo SA. The Densitometric Analysis of Protein Pattern in Cleft Lip and Palate Patients. J Int Soc Prev Community Dent 2019; 9:240-244. [PMID: 31198695 PMCID: PMC6559042 DOI: 10.4103/jispcd.jispcd_388_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives Cleft lip and palate (CLP) belongs to the congenital anomaly that is clinically seen as cleft in lip, alveolar bone, palate, and nasal septum. The patients suffer from esthetic and various functional defects. CLP is resulted from impaired palatogenesis during the embryonic phase. The etiology of CLP is influenced by genetic, environmental, and combination of both. According to the literature, CLP is highly associated with defect in interferon regulatory factor 6 (IRF6) and poliovirus receptor-like (PVRL1) genes. The present study aimed to investigate the total protein profile and to identify protein IRF6 and PVRL1 in plasma of CLP patients. Materials and Methods Dot-Blot analysis was performed to identify protein target of IRF6 and PVRL1. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed in gel concentration 12% using plasma of CLP patients, their parents, and control population. The gels were stained by Coomassie blue afterward. Gels were analyzed through ImageLab 5.2.1 software. Results The intensity of major bands in CLP patients was darker than control group, but remains similar to the parents group. The target protein IRF6 and PVRL1 were positively identified through Dot-Blot. Retardation factor value was significantly different in major bands of CLP patients compared to control group. Conclusion There pattern of protein profile in CLP patients was different compared to non-CLP.
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Affiliation(s)
- Regina Purnama Dewi Iskandar
- Doctoral Student, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Orthodontics, Faculty of Dentistry, Airlangga University, Surabaya, Indonesia
| | - Annise Proboningrat
- Doctoral Student, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Amaq Fadholly
- Doctoral Student, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Ida Bagus Narmada
- Department of Orthodontics, Faculty of Dentistry, Airlangga University, Surabaya, Indonesia
| | - Chairul Anwar Nidom
- Department of Veterinary Basic Medicine, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
| | - Sri Agus Sudjarwo
- Department of Veterinary Basic Medicine, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
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Santos RDS, Janini JP, Oliveira HMDS. The transition of breastfeeding children with cleft palate and lip among women. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2018-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To discuss the maternal transition in the breastfeeding process of children with cleft lip and palate, from the perspective of the transition theory. Method: Qualitative research of the case study type. The semi-structured interview was used as a data collection instrument. The results were analyzed from the Transition Theory. Results: The participant presented the transitions: situational, developmental and health-illness due to the change of social roles, the need to care for the child with malformation and the changes in her life due to her child's illness. It was identified, in the participant, the difficulty of exercising maternal breastfeeding care, interfering in its developmental and situational transition. Conclusion and implications for practice: The transitions were ineffective in taking into account the transitions covered. The presence of a nursing professional in the evaluation, follow-up and supplementation of the mother in the suckling of children with cleft lip and palate is essential to achieve the healthy transition.
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Abstract
It may be easy to discount oral health in infancy because most infants are not born with teeth and only a few teeth erupt during the first year of life. Infancy, however, is a critical time for formation of habits. Positive habits, such as twice-daily brushing with fluoride toothpaste starting at first teeth eruption, provides topical fluoride, which is important for remineralization of the tooth and helps establish a lifelong healthy practice. Negative habits, such as bottle propping and frequent juice consumption, reinforce behaviors that promote caries and obesity. This article reviews normal dental development and eruption. Congenital anomalies affecting the mouth as well as acquired conditions, primarily dental caries, are reviewed. Oral health preventive modalities, including professionally applied products and home-based strategies, are discussed.
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Whittemore KR, Dargie JM, Dornan BK, Boudreau B. Otolaryngology Service Usage in Children With Cleft Palate. Cleft Palate Craniofac J 2018; 55:743-746. [DOI: 10.1177/1055665617752210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Design: Retrospective case series. Setting: Specialty clinic at a pediatric tertiary care hospital. Patients: Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Main Outcome Measures: Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). Results: In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Conclusions: Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.
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Affiliation(s)
- Kenneth R. Whittemore
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Jenna M. Dargie
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Briana K. Dornan
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Brian Boudreau
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
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