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Infant orthopedics in UCLP: effect on feeding, weight, and length: a randomized clinical trial (Dutchcleft)
Charlotte Prahl1, Anne M Kuijpers-Jagtman, Martin A Van 't Hof
1Department of Orthodontics and Oral Biology, University Medical Center Nijmegen, Nijmegen, Netherlands.
Insights
Infant orthopedics (IO) did not significantly improve feeding or growth in infants with unilateral cleft lip and palate. These findings suggest that IO may not be necessary for optimizing nutritional status in these patients.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Neonatal care
Background:
- Infants with unilateral cleft lip and palate (UCLP) often experience feeding difficulties.
- Infant orthopedics (IO) is a treatment aimed at improving feeding and nutritional status in infants with UCLP.
Purpose of the Study:
- To evaluate the impact of infant orthopedics (IO) on feeding efficiency, weight, and length in infants with UCLP.
- To determine if IO improves nutritional outcomes in infants with UCLP.
Main Methods:
- A prospective, two-arm randomized controlled trial was conducted in three academic Cleft Palate Centers.
- Infants with complete UCLP were randomized to receive IO (passive maxillary plates) or no IO during their first year.
- Feeding velocity, weight-for-age, length-for-age, and weight-for-length z scores were measured up to 24 weeks.
Main Results:
- Feeding velocity increased over time in both groups, with no significant differences between infants who received IO and those who did not.
- Weight-for-age, length-for-age, and weight-for-length z scores did not differ significantly between the IO and no-IO groups.
- Infants with UCLP in both groups showed lower mean z scores for weight-for-age and height-for-age compared to reference values during the first 14 months.
Conclusions:
- Infant orthopedics (IO) does not offer significant benefits for feeding or nutritional status in infants with unilateral cleft lip and palate.
- The use of IO in infants with UCLP can be discontinued, as it does not improve feeding or growth outcomes.
Objective:
To study the effects of infant orthopedics (IO) on feeding, weight, and length.
Design:
Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method.
Setting:
Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands.
Patients:
Infants with complete unilateral cleft lip and palate (UCLP), no other malformations.
Interventions:
One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO-) did not. All other interventions were the same for both groups.
Main Outcome Measures:
Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands' third nationwide survey on growth.
Results:
Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO- group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure.
Conclusion:
Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.