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Risk of pneumonia among children with cleft palate before and after palatoplasty: a population-based study

Yotam Eyni1,2, Tomer Kerman3,4, Dana Danino5

  • 1Faculty of Health Sciences, Department of Plastic Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel. yotameyni@gmail.com.

European Journal of Pediatrics
|December 2, 2024
PubMed

Insights

Children with cleft palate (CP) face a significantly higher risk of pneumonia and lower respiratory tract infections (LRTI). Surgical repair (palatoplasty) helps reduce this elevated risk, improving respiratory health outcomes.

Area of Science:

  • Pediatric Health
  • Otolaryngology
  • Infectious Diseases

Background:

  • Cleft palate (CP) can lead to velopharyngeal dysfunction, potentially increasing pneumonia risk, but clinical evidence is limited.
  • CP disrupts nasal and oral cavity separation, causing food regurgitation and theoretical risk of respiratory infections.
  • The association between CP and respiratory tract infections requires thorough assessment.

Purpose of the Study:

  • To assess the prevalence of pneumonia and lower respiratory tract infections (LRTI) in children with CP using a population-based approach.
  • To investigate the impact of palatoplasty on the risk of pneumonia and other infections in CP patients.

Main Methods:

  • Retrospective cohort study using medical records from Clalit Health Services, Israel (2013-2022), including 138,261 infants (166 with CP).
  • Poisson regression models were used to analyze the prevalence of pneumonia, LRTI, and urinary tract infections (UTI) before and after palatoplasty.
  • A sibling comparison study analyzed 129 preoperative and 55 postoperative pairs to control for genetic and environmental factors.

Main Results:

  • Preoperatively, children with CP showed significantly increased risks for pneumonia (RR: 5.8), LRTI (RR: 1.55), and UTI (RR: 5.27) compared to controls.
  • Post-palatoplasty, the risk for pneumonia remained statistically significant but reduced (RR: 2.55) for up to 5 years.
  • Sibling analysis revealed a higher preoperative pneumonia risk (RR: 7.07) that became non-significant postoperatively (RR: 1.44).

Conclusions:

  • Cleft palate is an independent risk factor for pneumonia in children.
  • Palatoplasty significantly reduces the risk of pneumonia in patients with CP.
  • CP patients experience elevated risks for pneumonia, LRTI, and UTI, which can be mitigated by surgical intervention.

Keywords:
Cleft palateInfectious diseasesPalatoplastyPneumonia

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