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Cheiloplasty associated to a palatal obturator in a preterm infant with a cleft lip and palate
H Bénateau1, A-S Trentesaux2, A Chatellier1
1Department of maxillofacial surgery, Caen university hospital, 14000 Caen, France.
Insights
Non-invasive ventilation (NIV) is challenging for preterm infants with cleft lip and palate due to air leaks. Premature surgical cleft repair enabled ventilation in a very low birth weight infant.
Area of Science:
- Neonatal care
- Pediatric surgery
- Respiratory support
Background:
- Non-invasive ventilation (NIV) and CPAP are standard for preterm infants.
- Cleft lip and palate (CLP) complicates respiratory management due to air leakage.
- Traditional ventilation methods are often ineffective in preterm infants with CLP.
Observation:
- A 29-week preterm male infant (900g) with unilateral CLP presented with ventilation difficulties.
- Standard NIV and CPAP were challenging due to significant air leakage through the cleft.
- A multidisciplinary team decided on early surgical intervention.
Findings:
- The infant underwent premature surgical cleft repair (cheiloplasty) on day 17.
- This early intervention successfully addressed the ventilation challenges.
- This is the first reported case of cheiloplasty in a 900g preterm infant to facilitate ventilation.
Implications:
- Early surgical repair of CLP may be crucial for effective respiratory support in extremely preterm infants.
- This case highlights the need for tailored management strategies for preterm infants with CLP.
- Further research is warranted to optimize ventilation and surgical timing in this vulnerable population.
Introduction:
Preterm infants are commonly treated by non-invasive ventilation (NIV) and nasal continuous positive airway pressure (CPAP), which are associated with fewer complications than nasotracheal intubation. In preterm infants with a cleft lip and palate, this method of respiratory management is difficult or impossible to perform because of air leakage through the cleft defect.
Case:
We report a male infant who was born at 29 weeks of gestation with a left complete unilateral cleft lip and palate. Birth weight was 900 grammes. Because of the cleft, we have any problems to ventile this infant. We decide to close the cleft prematurely on day 17 after multidisciplinary discussion.
Discussion:
NIV cannot be performed with the usual equipment in very premature infants with a cleft lip and palate because of air leakage through the cleft defect. Very few studies report pre term infant with cleft lip and palate and his difficulties of ventilation. This is the first case reported to perform cheiloplasty on a 900g preterm infant.
