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Growth in Children with a Cleft Lip and/or Palate in 8 US Hospitals: A Retrospective Cohort Study
C M McKinney1,2,3, W Howard2, K Bijlani2
1University of Washington, Seattle, WA, USA.
Insights
US children with clefts experience slower growth initially, with weight catch-up by 12 months. These children show high rates of underweight and stunting, varying by cleft type and hospital care.
Area of Science:
- Pediatric Health
- Growth and Development
- Cleft Lip and Palate Research
Background:
- Cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) can impact child development.
- Understanding growth patterns in these children is crucial for early intervention.
Purpose of the Study:
- To evaluate growth patterns in US children with clefts from 0 to 18 months.
- To analyze growth differences based on cleft type (CL, CLP, CP) and across different children's hospitals.
Main Methods:
- Retrospective cohort study of 10,223 children with clefts from 2009-2022.
- Utilized electronic health data from 8 US children's hospitals.
- Analyzed weight-for-age z scores (WAZ) and length-for-age z scores (LAZ) using generalized linear mixed models.
Main Results:
- Growth trajectories showed a decline in the first 4 months, followed by significant weight catch-up between 6-18 months.
- Children with clefts exhibited higher prevalence of underweight and stunting compared to WHO standards.
- Growth deficits were most pronounced in children with CP, followed by CLP and CL, with hospital variations noted.
Conclusions:
- Children with clefts experience initial growth deceleration followed by weight catch-up, but overall high rates of underweight and stunting persist.
- Growth variations across hospitals suggest potential impact of care patterns.
- Close monitoring of growth in the first 4 months is recommended for infants with clefts.
Objectives:
To evaluate growth patterns in US children with cleft overall and by cleft lip (CL), CL and palate (CLP), and cleft palate (CP) across US children's hospitals from 0 to 18 mo of age.
Design:
We conducted a retrospective cohort study leveraging medical records from 2009 to 2022 in children with a cleft seen at 8 US children's hospitals.
Participants:
Individuals with a cleft seen at a PEDSnet consortium hospital.
Exposure:
We examined growth over time, by cleft type, and across hospitals.
Main Outcomes:
We used electronic health data to generate weight-for-age z scores (WAZ) and length-for-age z scores (LAZ), as well as underweight (WAZ <-2) and stunting (LAZ <-2). We tracked longitudinal growth using generalized linear mixed models to estimate mean WAZ and LAZ from 0 to 18 mo of age. We compared the prevalence of underweight and stunting against World Health Organization growth standards.
Results:
Our sample included 10,223 children: 19.1% with CL, 31.7% with CLP, and 49.2% with CP. WAZ and LAZ trajectories showed a fast rate of decline in the first 4 mo of life (P < 0.001). Between 6 and 12 mo and between 12 and 18 mo, WAZ showed a significant nonlinear increase in growth (P < 0.01) while LAZ remained unchanged (P > 0.05). All children had a higher prevalence of underweight and stunting relative to World Health Organization growth standards. Underweight and stunting were highest among those with CP, followed by CLP and then CL, and varied across hospitals.
Conclusions:
Growth trajectories were slower in the first 4 mo of life, followed by rapid catch-up in weight to 12 mo of age. Children with cleft had a high prevalence of underweight and stunting at all ages. Variability across hospitals suggests that care patterns may affect growth. Close growth monitoring in the first 4 mo in children with cleft may be warranted.Knowledge Transfer Statement:US children with a cleft of the lip and/or palate have substantial growth deficits that vary by cleft type, comorbidities, and across hospitals, particularly in the first 4 mo of life.
