A Cross-Sectional Study of the Nutritional Status of Infants with Orofacial Clefts in the First 6 Months of Life.

OBJECTIVE(S): To estimate nutritional status in a large cohort of infants with orofacial clefts in the US, overall and by cleft type from birth to 6 months of age. STUDY DESIGN: We conducted a cross-sectional study in infants with orofacial clefts by examining growth by month between birth and 6 months of age. Infants with at least one weight measurement at a single US regional tertiary care pediatric hospital with an interdisciplinary cleft team between 2010 and 2020 were included. We calculated the average weight-for-age z scores and weight-for-length z scores. We calculated the proportion of infants underweight and wasting with z scores below -2 SDs monthly from birth to 6 months of age. We used t tests to compare the distribution of weight for age z-score and weight for length z-score among children with orofacial clefts to a normal distribution. RESULTS: We included 883 infants with orofacial clefts. Compared with expected proportion of underweight infants (2.3%), a larger proportion of infants with orofacial clefts were underweight between birth and 1 month (10.6%), peaking between 2 and 3 months (27.1%), and remaining high between 5 and 6 months (16.3%). Compared with the expected proportion of infants with wasting (2.3%), a higher proportion of infants with orofacial clefts experienced wasting between birth and 1 month (7.3%), peaking between 2 and 3 months (12.8%), and remaining high between 5 and 6 months (5.3%). Similar findings were observed for all cleft types and regardless of comorbidities. CONCLUSION(S): A substantial proportion of infants with orofacial clefts compared with normative peers have malnutrition in the first 6 months of life in the US.

Growth patterns between 0 to 36 months of age among U.S. children with orofacial cleft: A retrospective cohort study.

BACKGROUND: Little is known about how young children with orofacial cleft grow over time. OBJECTIVE: To characterize longitudinal growth patterns from 0-36 months of age in U.S. children with an orofacial cleft. DESIGN: A retrospective cohort study. PARTICIPANTS/SETTING: Children with cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP) who were <36 months of age at a hospital encounter between 2010-2019 (N=1334) were included. The setting was a U.S. tertiary care children's hospital with a cleft center that serves a 5-state region. MAIN OUTCOME MEASURE: Weight-for-age z-scores (WAZ) and length-for-age z-scores (LAZ). STATISTICAL ANALYSES PERFORMED: Longitudinal growth patterns were characterized using generalized linear mixed models to estimate mean WAZ and LAZ from 0 to 36 months of age. RESULTS: Growth in infants with cleft slowed dramatically in the first 3 to 4 months of life, rebounded with catch-up growth until 12 months of age for CL and CP and until 36 months for CLP. When comparing populations, children with any type of cleft demonstrated subpar growth compared to WHO standards. Growth deficits were more common in those with CLP and CP compared to those with CL. The intraclass coefficient (ICC) showed that most of the variability in the WAZ (65%) was between individuals while 35% was within an individual. The ICC for LAZ showed that most of the variability in the LAZ (74%) was between individuals while 26% was within an individual. The proportion of variance attributable to cleft type and/or comorbidities accounted for less than 5% of the variance for WAZ and LAZ. WAZ and LAZ were lower in children with comorbidities than those without comorbidities with cleft and WHO standards. CONCLUSION: Infants with CLP and CP, and cleft plus comorbidities have higher rates of poor growth than their peers with CL and no comorbidities, respectively.