Survey of Parent Experiences in Prenatal Visits for Infants with Cleft Lip and Palate

Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients

OBJECTIVE

Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes.

DESIGN

Retrospective review and outcomes analysis (n = 740).

SETTING

Urban academic tertiary care center.

PATIENTS

740 patients undergoing primary (CL/P) surgery from 2009 to 2019.

MAIN OUTCOMES MEASURES

Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery.

RESULTS

Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, p = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, p = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, p < 0.001). Lower patient median block group income predicted later age at cleft lip (β = -67.25, p = 0.011) and cleft palate (β = -46.35, p = 0.050) repair surgery.

CONCLUSIONS

Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.

The Family Impact of a Robin Sequence Prenatal Diagnosis

OBJECTIVE

Assess the impact of prenatal diagnosis of Robin sequence (RS) on parental experience during gestation and early infancy.

DESIGN

Prospective case-control study. An online survey was administered via email to 44 parents representing 34 unique patients with RS.

PARTICIPANTS

Parents of children diagnosed with RS and who received mandibular distraction at our tertiary care children's hospital. Participants were separated by the timing of RS diagnosis into prenatal and control postnatal groups.

MAIN OUTCOME MEASURES

Effects of timing of diagnosis on parents' preparation, caregiver support, education about the condition, stress, and overall mental health.

RESULTS

Complete responses were received from 44 parents representing 34 unique patients (50% response rate): prenatal, n = 17; postnatal, n = 27. Prenatal diagnosis improved parents' satisfaction regarding time to prepare for treatment (P = .001), stress of uncertainty about their child's health (P = .018), and stress about the operation(s) their child would need (P = .001). Both the prenatal (82%) and postnatal (78%) groups reported a negative impact on mental health based on diagnosis timing. All parents in the prenatal group preferred having received a prenatal diagnosis and the majority of the postnatal group (85%) would have preferred to have received the diagnosis prenatally.

CONCLUSIONS

Prenatal diagnosis of RS provided tangible benefits for parents by allowing them to mentally prepare, make plans for delivery and treatment, and become educated about the condition. Parents in both groups reported a negative impact on their mental health based on diagnosis timing and the majority of parents consistently preferred prenatal diagnosis.

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

OBJECTIVE

Information regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.

DESIGN

PSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).

RESULTS

Two themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.

CONCLUSION

Multifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

Craniofacial Surgery-Related Hashtag Utilisation on Instagram

BACKGROUND

Patients, parents, and carers are increasingly using social media to access and contribute to health information. There are currently 3.484 billion active social media users. Instagram is a primarily visual social media platform for sharing photographs and videos with currently over one billion monthly active users. Limited research has investigated the use of Instagram in healthcare contexts including plastic surgery, and in the treatment of specific conditions, such as fibromyalgia and scoliosis. This study aimed to investigate the use of Instagram in relation to craniofacial surgery.

METHODS

The authors investigated the use of 12 Instagram craniofacial surgery-related hashtags. Quantitative and qualitative data were collected for each of the "top" nine posts associated with each hashtag. Duplicate posts, posts not in English and those not relevant to craniofacial surgery were excluded.Thematic analysis was then used to qualitatively evaluate the captions and comments of each of the nine "top" posts associated with each hashtag.

RESULTS

A total number of 151,738 posts were identified using the 12 hashtags queried in the present study, with #craniofacial being the most popular hashtag (87% of posts). Parents (n = 25, 33%) and surgeons (n = 25, 33%) were responsible for the majority of posts. A heterogenous group were responsible for the remaining 34% of posts.Results indicated that parents and surgeons posted significantly different images (chi-squared with Yates correlation is 25.0519, P  < 0.00001). Parents' posts were predominantly images of their child/patients (n = 24) compared to posts about patients by surgeons (n = 6). Posts by surgeons were predominantly images of professionals (n = 14) compared to images of professionals posted by parents (n = 1).Results of qualitative analysis of captions of posts indicated a significant difference in themes that emerged between parents and surgeons; with surgeons largely using Instagram for information giving, and parents for sharing of experiences (chi-square (n = 108) = 40.83, P  < 0.00001).There was a significant difference (two-tailed t test, P  = 0.002) in engagement (measured by the number of likes on posts) on posts by parents (mean = 3778) compared to posts by surgeons (mean = 135.4).

CONCLUSIONS

Results indicate that craniofacial-surgery related posts on Instagram provide a medium to allow individuals and families with rare disorders to connect and share their experiences. The use of Instagram to share information about craniofacial abnormalities via Instagram has the potential to be used by healthcare professionals to educate and support patients and families.

Discussion on Ultrasound Diagnosis of Prenatal Cleft Lip: How does Its Accuracy Affects the Family? Prenatal Counseling for Clefts: The University of Illinois at Chicago, Craniofacial Center's Protocols and Experience

ABSTRACT

Prenatal diagnosis of cleft lip and palate as well as other craniofacial differences is now possible with a significant level of accuracy due to sonographic and other evaluations. Thus, prospective parents have the opportunity to be informed ahead of time about these conditions making them better prepared to deal with their child after birth. The role of the plastic surgeon and other craniofacial team members in prenatal consultations is becoming increasingly important and well accepted. Therefore, any additional publication reviewing the topic from different angles and specifically from the parents' perspective is a welcome addition to our understanding of the parents' points of view and enables the team to most effectively assist them as they cope with the new diagnosis.This review describes details about our Craniofacial Center's efforts over 24 years. Our focus has always been on providing support through face-to-face multidisciplinary consultations with prospective parents as well as offering education to the public and referring sources, such as obstetricians and sonographers through direct communications, newsletters, and our website for timely referrals. As an additional service, the authors have organized a group of volunteer parents of children who are patients of the Center to share their short long-term experiences.

What is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care

ABSTRACT

In the pediatric general surgery literature, it has been shown that prenatal diagnosis of a congenital anomaly is an independent predictor of parental psychological distress. Surgical prenatal counseling can decrease parental anxiety by helping families understand the surgical needs and potential outcomes of their infant. In this retrospective analysis (n = 440), the authors sought to present our care pathway for prenatally diagnosed cleft lip and palate (CL/P) and explore the impact of cleft lip and palate-specific prenatal counseling on patient care by comparing the timing of clinical and surgical care between a cohort of patients who received prenatal CL/P consultation and a cohort of patients only seen postnatally. The authors hypothesize that our multidisciplinary prenatal care intervention is associated with earlier postnatal clinic visits and surgical repair. The care of all patients whose mother's presented for prenatal CL/P consultation (prenatal cohort, n = 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n = 322) from January 2015 through August 2019. 81.4% (n = 96) of the prenatal cohort returned for care postnatally while 2 pregnancies were interrupted, four neonates died, and 15 patients did not return for care. Prenatal consultation was associated with earlier postnatal clinic appointments (P < 0.001) as well as a shorter time to CL repair in patients with CL only (P = 0.002) and CLP (P = 0.047). Our described pre- and postnatal CL/P pathway is a multidisciplinary model associated with high retention rates from the prenatal period through complete surgical repair.

Analysis of Instagram® Posts Referring to Cleft Lip

Background: Social media has become a source of medical information. Cleft lip and palate is a visible congenital anomaly. The aim of the study was to analyze Instagram^® posts on the topic of cleft lip. Methods: Instagram^® posts with “#cleftlip” from March 2014–March 2017 were accessed. Separate lists of expressions (hashtags, meaningful words, words with emojis or emojis alone) were prepared for primary posts and for replies. Thirty expressions statistically most frequent in primary versus secondary posts and 30 in secondary versus primary posts were identified (Group 1) as well as 30 English words or hashtags (Group 2), non-English words or hashtags (Group 3) and emojis (Group 4). The frequencies of expressions were compared (Z-test for the difference of two population proportions). Results: There were 34,129 posts, (5427 primary posts and 28,702 replies), containing 62,163 expressions, (35,004 in primary posts). The occurrence of all expressions was 454,162, (225,418 in primary posts and 228,744 in replies). Posts with positive expressions such as “beautiful”, “love”, “cute”, “great”, “awesome” occurred more often than these with negative ones. In replies all emojis were positive. Conclusions: Numerous Instagram^® posts referring to cleft lip are published and do provoke discussion. People express their solidarity and sympathize with persons affected by cleft.

Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress

OBJECTIVE

To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P).

DESIGN

Cross-sectional.

SETTING

Pediatric academic medical center in the Midwestern United States.

PARTICIPANTS

Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments.

MAIN OUTCOME MEASURE(S)

Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained.

RESULTS

Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = -0.31, P = .02) and length (r = -0.32, P = .02).

CONCLUSIONS

Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.

#Cleftlip/Palate: What Is the World Talking About?

Objective:

Studies have begun analyzing how the world converses on social media platforms about medical/surgical topics. This study’s objective was to examine how cleft lip and palate, two of the most common birth defects in the world, are discussed on the social media platform Twitter. No study to date has analyzed this topic.

Methods:

Tweets were identified using any of the following: cleft, cleft lip, cleft palate, #cleft, #cleftlip, #cleftpalate. Eight months between 2017 and 2018 were analyzed.

Main Outcome Measures:

The primary outcome was the tweet subject matter. Secondary outcomes were author characteristics, tweet engagement, multimedia, and tweet accuracy

Results:

A total of 1222 tweets were included. #Cleft was the most common hashtag (71%), and it was significantly associated with more retweets ( P = .03). Twenty-seven countries tweeted, with the United States (34%) and India (27%) producing the most. Charities (36%), hospitals (14%), and physicians (13%) were the most common authors. Over three-quarters of tweets were self-promotional. The top content included charity information (22%) and patients’ cleft stories (14%). Tweets about patient safety/care and surgical service trips generated the most engagement. The accuracy of educational tweets was 38% low accuracy and 1% inaccurate. One hundred forty-nine tweets (12%) discussed a published research article, but 41 tweets did not share a link.

Conclusions:

Charities dominate the cleft lip/palate “Twitterverse.” Most tweets were self-promotional, and over a third of educational tweets were low accuracy. As the cleft social media community continues to grow, we recommend using the hashtag #cleft to reach a wider audience.

Breast Milk Feeding Practices and Barriers and Supports Experienced by Mother–Infant Dyads With Cleft Lip and/or Palate

Objective:

To examine trends in breast milk provision and to characterize the breast milk feeding practices experienced by mother–infant dyads with cleft lip and/or palate (CL/P) in a large US sample.

Design:

Cross-sectional study.

Methods:

An online survey was distributed through cleft-related social media sites in the United States and in a single cleft lip and palate clinic. Statistical analyses included Kruskal-Wallis H tests and post hoc Mann-Whitney tests to examine group differences based on cleft type and prenatal versus postnatal cleft diagnosis. Linear regression was used to estimate associations between obtained variables.

Participants:

One hundred fifty biological mothers of infants (8-14 months of age) with CL/P (15% cleft lip, 29% cleft palate, 56% cleft lip and palate).

Results:

Forty-six percent of mothers of infants with CL/P provided breast milk to their infant for at least 6 months. Five percent of infants ever fed at breast, and 43% received pumped breast milk via bottle. The most commonly reported supports included lactation consultants, nurses, feeding therapists, and online support groups. Feeding therapy was received by 48% of infants.

Conclusions:

A lower percentage of mothers of infants with CL/P reported providing breast milk compared to national estimates of the general population of infants without clefting. Results suggested there are multiple barriers, as well as numerous medical and psychosocial supports that facilitated breast milk feeding success. Implications for care are discussed.

Assessing Burden of Care in the Patient With Cleft Lip and Palate: Factors Influencing Completion and Noncompletion of Nasoalveolar Molding

OBJECTIVE

Evaluate the factors that influence caregiver-reported completion of nasoalveolar molding (NAM) therapy for patients with cleft lip and palate.

DESIGN

An IRB-approved 30-question survey.

SETTING

Outpatient clinic for patients with cleft lip.

PATIENTS

Patients with unilateral or bilateral cleft lip treated with NAM therapy.

INTERVENTIONS

Survey of previous experiences.

MAIN OUTCOME MEASURE(S)

Rate of noncompletion for patients initiating NAM therapy and identifiable causes.

RESULTS

Of 94 patients who underwent NAM, 13 (13.8%) failed to complete NAM therapy. Reasons for incomplete treatment included: obstructive sleep apnea, device intolerance, tape issues, and lack of support. Patients who did not complete NAM therapy were less likely to have primary caregivers >30-year old (P = .045) and more likely to be the first child for the family (P = .021) and have a bilateral cleft (P = .03). Caregivers of NAM patients were less satisfied with the outcome (P < .001) when they did not complete therapy.

CONCLUSION

This study shows that a high number of parents fail to complete this therapy for many reasons, personal and medical. More data are needed to elucidate true prevalence of NAM noncompletion and to establish evidence-based guidelines to reduce barriers to care for completing NAM treatment.

Psychological Effect of Prenatal Diagnosis of Cleft Lip and Palate: A Systematic Review

Introduction and Background:

Cleft lip and/or palate is the most common congenital craniofacial anomaly. Prenatal diagnosis of the craniofacial anomalies is possible with the advent of newer imaging modalities. The identification of the defect at an early stage in the pregnancy helps the parents to be well informed and counseled regarding the treatment possibilities and outcomes of cleft lip and palate (CLP) treatment.

Objectives:

To analyze the psychological effects of prenatal diagnosis of CLP on the parents.

Materials and Methods:

PubMed, Cochrane, and Google Scholar searches were made with search strings “prenatal diagnosis cleft lip palate,” “antenatal diagnosis,” “anomaly scan,” “psychological effect cleft lip palate,” and “prenatal counseling cleft lip palate.” Of the results obtained, studies which evaluated the psychological aspects of parents of cleft children were further included in the study.

Results:

Electronic search yielded 500 articles after duplication removal. Forty studies concentrated on the results of the scan and their implications predominantly in the diagnosis and management of cleft and other related abnormalities. Eight studies discussed the effects of prenatal diagnosis and counseling on the parents.

Conclusion:

Prenatal diagnosis enables appropriate and timely counseling of the parents by the cleft team and helps instill a sense of preparedness for the family which highly improves the quality of treatment received by the child enabling a near-to-normal quality and standard of life.