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Cleft Lip and Palate in Infants With Prenatal Opioid Exposure
Olivia Langa1, Alex T Cappitelli1, Ingrid M Ganske1
1Department of Plastic and Oral Surgery, 1862Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Insights
Infants with cleft lip/palate and prenatal opioid exposure often have complex medical and social needs. These challenges can lead to delayed surgeries, but postoperative outcomes were positive in this study.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Neonatal care
Background:
- Prenatal opioid exposure is a growing concern impacting infant health.
- Cleft lip and/or palate (CL/P) require surgical intervention.
- Understanding the unique needs of infants with CL/P and prenatal opioid exposure is crucial for optimal care.
Purpose of the Study:
- To examine the phenotypic characteristics of CL/P in infants with prenatal opioid exposure.
- To evaluate perioperative outcomes of cleft-related procedures in this vulnerable population.
- To identify associated medical and social comorbidities impacting care.
Main Methods:
- Retrospective review of 18 infants with CL/P and documented prenatal opioid exposure (2008-2018).
- Phenotypic characterization of CL/P.
- Analysis of demographic data, additional exposures, comorbidities, operative delays, perioperative complications, and follow-up.
Main Results:
- Isolated cleft palate and Robin sequence were overrepresented.
- Most infants had co-exposures (56%), other medical conditions (67%), or genetic syndromes (17%).
- Significant delays in operative dates (39%) occurred due to medical/social factors; no readmissions, but 33% loss to follow-up.
Conclusions:
- Infants with CL/P and prenatal opioid exposure present with significant medical complexity and social challenges.
- These factors contribute to operative delays, highlighting the need for multidisciplinary support.
- Despite challenges, cleft repair outcomes were favorable, though follow-up remains an issue.
Objective:
This study examines phenotypic presentation and perioperative outcomes of cleft-related procedures for infants with cleft lip and/or palate (CL/P) and prenatal opioid exposure.
Design:
This is a retrospective review of infants with prenatal opioid exposure treated for CL/P from 2008 to 2018.
Setting:
Patients cared for at a tertiary center from 2008 to 2018.
Patients/Participants:
Eighteen patients with documented prenatal opioid exposure and CL/P had primary repairs in our unit.
Main Outcome Measure(S):
The phenotypes of CL/P were characterized. Demographic data regarding additional exposures, as well as associated medical and social comorbidities were recorded. Outcome variables included operative delays, perioperative complications, and loss of follow-up.
Results:
Isolated cleft palate (CP; 67%) was overrepresented among patients with prenatal opioid exposure and CL/P, as was Robin sequence (50% in isolated CP). Fifty-six percent had exposure to additional substances. A majority (67%) had other medical conditions or anomalies, and 17% had known genetic syndromes. Seventy-two percent were in state custody. Thirty-nine percent of exposed patients had delays in their planned operative dates due to medical and/or social factors. There were no postoperative readmissions following cleft procedures. Lack of follow-up was noted in 33% of patients.
Conclusions:
Infants with CL/P who have prenatal opioid exposure are likely to have additional medical conditions and complex social challenges.
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