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Delayed detection of cleft palate: an audit of newborn examination
A Habel1, N Elhadi, B Sommerlad
1North Thames Cleft Lip and Palate Centre, Great Ormond Street Hospital for Children, UK. alex.habel@btinternet.com
Insights
Delayed detection of cleft palate occurs in 28% of cases, particularly isolated or syndromic clefts. Improved neonatal screening using visual inspection is recommended to enhance early identification.
Area of Science:
- Neonatal clinical examination
- Pediatric surgery
- Craniofacial anomalies
Background:
- Cleft palate is a common congenital anomaly.
- Timely diagnosis is crucial for optimal infant feeding and development.
- Current neonatal screening practices may miss certain cleft palate presentations.
Purpose of the Study:
- To determine the prevalence of delayed cleft palate detection.
- To identify factors associated with delayed diagnosis.
- To inform improvements in neonatal clinical examination protocols.
Main Methods:
- Retrospective audit of hospital records for 344 patients.
- Parental questionnaires assessing detection timelines and symptoms.
- Telephone surveys of junior doctors regarding examination techniques.
Main Results:
- 28% of cleft palates were detected after the first day; 37% for isolated, 23% for syndromic.
- Narrow, V-shaped, and soft palate clefts were more prone to delayed detection.
- Feeding problems and nasal regurgitation were more frequent in delayed detection cases.
- Digital examination was common among trainees, with limited specific palate examination training.
Conclusions:
- Delayed cleft palate detection is a significant issue.
- Cleft palate characteristics and examination methods (digital vs. visual) are linked to detection delays.
- Enhanced training for healthcare professionals on visual and digital palate examination is warranted.
Aims:
To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination.
Methods:
Audit of hospital notes, parental questionnaire incorporating open ended questions, and telephone questionnaire of junior doctors in the referring hospitals incorporating fixed choice questions.
Results:
Of 344 cleft palate patients without cleft lip or submucous cleft palate, the day the cleft was detected was recorded in 92%. Delayed detection, after the first day, was 28% overall, distributed as 37% with isolated cleft palate and 23% with syndromic cleft palate. Narrow V shaped clefts were more likely to be delayed in detection compared with broad U shaped clefts, as were soft palate clefts compared with hard palate clefts. Five with isolated cleft palates were not detected until after the first year. Babies born at home were unlikely to be detected on day 1. Symptoms were significantly increased in the delayed detection group for feeding problems and nasal regurgitation. A telephone questionnaire of trainee paediatricians in referring units revealed that digital examination was more commonly practised than visual inspection, and few recalled receiving specific instruction on examination of the palate.
Conclusion:
Delayed detection of cleft palate was not uncommon, and the features of those more likely to be missed suggested digital examination was related. Trainee doctors and midwives should be instructed to inspect visually using a light and tongue depressor, then digitally if submucous cleft palate is suspected.
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