Faltering Growth in Cleft Lip/Palate: How Far Have We Come?

Area of Science:

• Pediatric surgery
• Growth and development
• Craniofacial anomalies

Background:

• Faltering growth (FG) is common in infants with cleft lip and/or palate (CLP), often linked to feeding difficulties.
• Previous studies indicated high FG rates (e.g., 43.3% in palatal clefts) before UK cleft service centralization.
• Anticipation of reduced FG levels post-centralization and early intervention by cleft nurse specialists.

Purpose of the Study:

• To determine the prevalence of FG in infants with CLP after service centralization.
• To compare current FG rates with pre-centralization data.
• To analyze FG variations based on cleft type and syndromic status.

Main Methods:

• Utilized data from the Cleft Collective longitudinal cohort study.
• Defined FG according to National Institute for Health and Care Excellence (NICE) guidelines.
• Compared FG prevalence using chi-squared tests and logistic regression against historical data (Pandya and Boorman, 2001).

Main Results:

• FG prevalence was 24% (NICE guidelines) and 29% (failure-to-thrive category).
• Infants with cleft palate (CP±L) showed a 3.3 times higher likelihood of FG compared to isolated cleft lip.
• A 78% decrease in FG odds was observed for syndromic/PRS cases post-centralization.

Conclusions:

• The study confirms a 29% prevalence of faltering growth in the Cleft Collective cohort.
• Moderate evidence suggests reduced FG odds in syndromic/PRS cases over 20 years.
• Centralization of services and early nurse specialist intervention are likely drivers of improved FG outcomes.