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Are children with clefts underweight for age at the time of primary surgery?
D D Lazarus1, D A Hudson, A N Fleming
1Department of Plastic and Reconstructive Surgery, Red Cross Children's Hospital, Cape Town, South Africa.
Insights
Children with cleft lip and/or palate are significantly more likely to be underweight before surgery. Cleft palate type and delayed surgery increase the risk of poor nutritional status in these children.
Area of Science:
- Pediatric Surgery
- Craniofacial Anomalies
- Nutritional Science
Background:
- Children with clefts, particularly cleft palate, often experience feeding difficulties due to impaired sucking mechanisms.
- These feeding challenges can lead to nutritional problems and impact overall child development.
Purpose of the Study:
- To investigate the prevalence of being underweight for age in children with cleft lip and/or palate prior to primary surgical repair.
- To identify factors associated with underweight status in this pediatric population.
Main Methods:
- Retrospective review of medical records for 640 children with clefts treated between 1976 and 1996.
- Comparison of underweight prevalence between children with clefts and a control group of non-cleft children.
- Analysis of cleft type and age at surgery as potential influencing factors.
Main Results:
- Over 30% of children with clefts were underweight for age, significantly higher than the 13.7% in non-cleft controls.
- Children with cleft palate (with or without cleft lip) were more likely to be underweight than those with isolated unilateral cleft lip.
- Surgery after one year of age increased the likelihood of being underweight by 1.5 times.
Conclusions:
- Children undergoing primary surgery for cleft lip and/or palate exhibit a high prevalence of being underweight for age.
- Type of cleft and delayed surgical intervention are significant risk factors for poor nutritional status.
- Early surgical management may be crucial for improving nutritional outcomes in children with clefts.
Abstract:
Children with clefts, especially those with a cleft palate, have an impaired sucking mechanism and are therefore prone to nutritional problems. This study was undertaken to determine whether children with clefts of the lip and/or palate are underweight for age at the time of primary surgery. Underweight for age was defined as being less than 80 percent of expected weight for age or below the 3rd percentile as plotted on standard percentile charts. The records of all children with clefts seen at the Red Cross Children's Hospital between 1976 and 1996 were reviewed. Of these 740 records, 100 were excluded for inadequate data (47), severe systemic syndrome (27), no operation done (22), or craniofacial cleft (4). The records of 640 children were thus included; 195 (30.5 percent) were underweight for age. By comparison, only 13.7 percent of a similar group of noncleft controls (n = 872) were underweight for age. The difference between these two groups was highly significant (p < 0.01). Factors that influenced weight at the time of primary surgery were type of cleft and age at the time of surgery. Children with cleft palate, whether associated with a cleft lip or not, were found to be more underweight for age than those with an isolated unilateral cleft lip (p = 0.008). Children who had surgery after the age of 1 year were 1.5 times more likely to be underweight for age than children who had surgery under 1 year of age (p < 0.01). Children with isolated cleft palates who were underweight for age had a tendency toward a higher fistula rate (36 percent) than those of normal weight (24 percent) (p = 0.18).