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Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain
Katelyn Kondra1,2, Eloise Stanton1,2, Christian Jimenez1,2
15150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Early cleft lip repair (ECLR) leads to better weight gain in infants compared to traditional lip repair (TLR), with or without nasoalveolar molding (NAM). This finding suggests ECLR may improve nutritional outcomes for infants with cleft lip.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Infant Nutrition
Background:
- Cleft lip repair timing is crucial for infant development.
- Traditional lip repair (TLR) may be associated with feeding difficulties.
- Nasoalveolar molding (NAM) is an adjunct used in some cleft lip treatments.
Purpose of the Study:
- To compare weight gain in infants undergoing early cleft lip repair (ECLR) versus traditional lip repair (TLR) with or without NAM.
- To evaluate the impact of surgical timing on infant weight and nutritional status.
- To inform future treatment paradigms for cleft lip repair.
Main Methods:
- Retrospective chart review of 107 patients undergoing ECLR or TLR ± NAM.
- Data collection included demographics, medical history, and perioperative variables.
- Infant weights and age-based percentiles were recorded at multiple time points up to 24 months postoperatively.
Main Results:
- ECLR patients showed significantly greater weight changes from surgery to 8 weeks and surgery to 24 months compared to TLR ± NAM groups.
- ECLR group had significantly higher age-matched weights at multiple postoperative time points.
- Weight gain was notably better in ECLR compared to TLR without NAM after 6 months.
Conclusions:
- Early cleft lip repair (ECLR) significantly enhances patient weight gain up to 24 months postoperatively compared to traditional lip repair (TLR) ± NAM.
- ECLR demonstrates potential to alleviate feeding challenges and malnutrition in infants with cleft lip.
- Surgical timing plays a critical role in optimizing growth outcomes for infants with cleft lip.
Objective:
This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms.
Design:
Retrospective review.
Setting:
Children's Hospital of Los Angeles, California.
Patient, Participants:
A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020.
Interventions:
No intervention was performed.
Main Outcome Measure(S):
Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups.
Results:
107 patients met inclusion criteria: ECLR, n = 51 (47.6%); TLR + NAM, n = 35 (32.7%); and TLR-NAM, n = 21 (19.6%). ECLR patients had significantly greater changes in weight from surgery to 8-weeks and from surgery to 24-months postoperatively compared with both TLR ± NAM (P < .05). Age-matched weights in the ECLR group were significantly greater than TLR ± NAM at multiple time points postoperatively (P < .05).
Conclusions:
ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.
