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Cleft Lip Repair in Premature Infants With Cardiac Risk Factors
Christopher L Kalmar1, Vijay A Patel2, Jesse A Taylor1
1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Cleft lip repair is safe outpatient, but comorbidities increase hospitalizations. For premature infants with cardiac risks, delaying surgery until after 125 days and 10 lbs significantly reduces adverse events.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Congenital Anomalies
Background:
- Cleft lip repair is generally safe in outpatient settings.
- Patients with comorbidities have higher overnight hospitalization rates.
- Cardiac risk is the primary comorbidity associated with adverse outcomes in premature infants undergoing cleft lip repair.
Purpose of the Study:
- To investigate the association between comorbidities and adverse outcomes in premature infants undergoing cleft lip repair.
- To identify specific risk factors and potential interventions to mitigate adverse events in this population.
Main Methods:
- Retrospective analysis of patient data for cleft lip repair.
- Statistical analysis to determine the association between comorbidities, prematurity, age, weight, and adverse postoperative events.
- Comparison of adverse event rates based on age and weight cutoffs for surgery.
Main Results:
- Cardiac risk severity is significantly associated with adverse events across all degrees of prematurity (P ≤0.002).
- In premature infants with major cardiac risk factors, younger age (P=0.016) and lower weight (P=0.013) correlate with adverse events.
- Performing cleft lip repair after 125 days of age and >10 lbs body weight significantly reduced postoperative adverse events (P <0.001 for both).
Conclusions:
- Postponing cleft lip repair in premature infants with major cardiac risk factors until they are older than 125 days and weigh more than 10 lbs can significantly decrease postoperative adverse events.
- Optimizing surgical timing based on age and weight may be a crucial strategy for improving outcomes in high-risk premature infants.
Abstract:
Despite cleft lip repair having demonstrated safety when performed in the outpatient setting, patients with comorbidities are significantly more likely to be hospitalized overnight. There are several comorbidities overrepresented with inpatient admission, but only cardiac risk has any association with adverse outcomes in premature patients. The severity of cardiac risk is significantly associated with adverse events at all degrees of prematurity (P all ≤0.002). In premature patients with major cardiac risk factors, adverse events are significantly associated with younger age (P = 0.016) and lower weight (P = 0.013). Performing cleft lip repair on children older than 125 days (P < 0.001, before cutoff: 50.0% vs after cutoff: 6.4%) and weight greater than 10 lbs (P < 0.001, before cutoff: 56.4% vs after cutoff: 6.1%) provides a significant reduction in postoperative adverse events in premature patients with major cardiac risk factors.
