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OBJECTIVES/GOALS: Evaluate the impact of COVID-19 on oral clefts services including surgical and dental treatments in Puerto Rico. METHODS/STUDY POPULATION: This Observational retrospective cohort study will consider patients 0-21 y/o with CL/P that visited the UPR school of Dental Medicine, Pediatric University Hospital Dr. Antonio Ortiz and ongoing case-control research project Face-Genes. Records to be used are classified as follow: Pandemic (March 15, 2020 to March 15 2022) Pre-pandemic (March 15, 2015 to March 15, 2017) Power analysis (power=0.80 alpha=0.05) will be calculated. Unavailable and incomplete medical records and those that did not attended study clinic during study period will be excluded. Data extraction instrument will be based on previous published study. Descriptive statistics, Chi-square, Odds Ratios at 95% confidence intervals and multiple logistic regression will be estimated. RESULTS/ANTICIPATED RESULTS: We hypothesize that surgical and dental services in Puerto Rico will be adversely impacted because of COVID-19 pandemic. DISCUSSION/SIGNIFICANCE: CL/P are common congenital diseases that require early interdisciplinary attention. Lack of timely care as well as surgery and treatment delays, could be associated with poorer prognosis, increased morbidity and mortality. If there is high risk of dh services during emergency situations, our findings will help to allocate the available resources
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Objective: The objective of this study was to determine factors that may affect anesthesia and surgical complications, difficult airway, and the need for intensive care unit (ICU) care in cleft lip and cleft palate (CLCP) surgeries. Materials and Methods: The study was a retrospective review of the records of 617 patients who underwent CLCP surgery between 2015–2019. Results: The number of anesthesia complications was higher in patients with difficult mask ventilation. Surgical complications were more common in patients >1 year of age. Isolated cleft palate (CP) surgery;presence of a concomitant disease, syndrome, or micrognathia;age >1 year;and the CP subtype were associated with a higher rate of difficult intubation. Isolated cleft palate, concomitant disease, syndrome, micrognathia, difficult intubation, difficult mask ventilation, and anesthesia complications were associated with ICU admission. Conclusion: The CP subtype was associated with a higher rate of difficult intubation and ICU hospitalization even in patients who were nonsyndromic and/or >1 year of age. Therefore, special attention should be paid to the anesthesia and surgical management of these patients.
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Background/Purpose: Nutritional education and lactation support are key strategies to maintain a healthy nutritional status for a patient with cleft lip and palate. For this reason, specialized health personnel should receive up-to-date training and have the necessary tools for timely diagnosis and nutritional treatment. Smile Train organized a virtual course that included 15 modules of innovations in nutrition for partner centers in the Mexico, Central America, and the Caribbean during the SARS-COV2 pandemic. Methods/Description: The course was conducted virtually by two nutrition experts and five international guests in weekly sessions from August to November 2020. The course covered concepts of nutrition care, clinical evaluation, dietetics, feeding stages and approaches to associated disorders, malnutrition, overweight and selective feeding. During the course, participants evaluated sociodemographic variables, effectiveness, satisfaction, the confidence of acquired knowledge and application of knowledge in the short and medium term through questionnaires, which were validated statistically. Descriptive statistics, the Kolmogorov-Smirnoff normality test, Student's test for the effectiveness variable, and Fisher's exact test for dichotomous variables were used. Results: Sixty-eight health professionals from 26 comprehensive cleft care centers in 7 countries participated in the course. 90.2% of participants identified as female and 9.8% identified as male, with an average age of 38.42, and an average of 10 years of experience with cleft lip and palate. The course was effective in 97% of participants, which is an increase in percentage when comparing before [x=63.67 (45 89)] and after the course [x= 84.60 (65-95)], (p<0.001). The overall satisfaction of users was very high (9.78/ 10.0), and can be broken down to these categories: 1. Content and materials (9.84/10) 2. Course design (9.75/10) 3. Instructors and professors (9.8/10) 4. Acquired knowledge (9.73/10) 5. Organization (sending materials, evaluations and (9.84/10) 6. Recommendation of the course to colleagues (9.92/10) 7. Clarity of information (9.55/ 10) The confidence in the acquired knowledge and its possible application in the short and medium term was greater than 96%, given that the course provided tools for clinical application. 98.4% of participants considered the course to be stimulating, 98.2% have a greater interest in the subject, 98% considered learning new content in this area, 99% considered the course to be effective and to increase competencies on nutritional diagnosis and treatment. 98% of the professionals thought the course improved their clinical performance and 90.2% believed they had sufficient tools to change their nutritional practice in the short and medium term. Conclusions: The educational intervention on nutrition for patients with cleft was effective and highly satisfactory, confirming that a virtual space offers the possibility of execution, accessibility, and adoption of knowledge.
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Background/Purpose: Cleft Surgery in our centre is delivered by a single specialist surgeon in a regional Burns and Plastic service. We see 35-45 cleft-affected births per annum and, prior to the COVID-19 pandemic, ran 6 theatre lists per month, conducting 170-180 cleft procedures annually. The pandemic severely hindered elective operating in even tertiary centres, due to the redeployment of theatre staff and resources to manage the emergency care load. Cleft surgery was suspended entirely during the first wave (March-June 2020), before efforts in collaboration with the RCPCH (UK) to conserve the cleft pathway restored it as a priority. Primary palatine reconstruction is recommended at 6-9 months of age to optimise velopharyngeal function and speech proficiency by 5 years (Slater et al 2019). Our service was restarted at 1-2 ad hoc lists a month, which was both insufficient to manage ongoing demands and deal with rising outstanding cases. We faced a major challenge in safely distributing scarce surgical time and capacity across the entire cleft surgical burden. Therefore, we aim to examine our response to these limitations in the face of rising cases and time pressures, illustrating our methods in prioritising cleft procedures. Methods/Description: We reviewed the current literature to determine which of the main cleft procedures were most time critical, and compiled a cleft priority document with a broad evidence basis. Babies with palate involvement were top priority, in light of the strong evidence advocating primary palate repair by 13 months of age (CRANE 2020), after which there is a risk of speech delay (Shaffer et al 2020). Primary lip +/- alveolar involvement were prioritised lower and performed later (∼1 year), as cosmesis during infancy was deemed less detrimental, although there remained the psychological impact on the parent (Grollemund et al 2020). Secondary speech surgery was next, the lack of which can inhibit education and require intensive speech therapy to support patients (Baillie and Sell 2020). This was followed by alveolar bone grafting, ideally performed prior to canine eruption at ∼8-9 years to limit further dental reconstructions (Vandersluis et al 2020). As per national consensus, all adult cleft surgery was suspended to accommodate higher priorities. Focusing on early palate repair helped restart the cleft pathway and prevent functional delay as well as further interventions and schoolage support. However, late lip repair saw a rise in complications - two cases of dehiscence were associated with self-inflicted toddler trauma. This is in addition to the psychosocial implications of cosmesis, including early maternal interactions (Montirosso et al 2011), stigmatisation by peers (Bous et al 2021), and parental anxiety (Bous et al 2020). We recommend isolated lip reconstructions are also undertaken within 9 months. Long-term physical and psychosocial impacts of delay in surgery should guide resource allocation in the event of future operating limitations.
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Background/Purpose: During the COVID 19 pandemic in Brazil, for a period of six months to a year and by determination of the National Supplementary Health Agency (ANS), elective health procedures were suspended in public and private hospitals, including cleft lip and palate treatment. The measure took into account the high occupancy rates of Intensive Care Unit (ICU) beds in the country and the prevention of contamination. For a condition such as cleft lip and palate, can be harmful to the patient. To report the impacts on cleft lip and palate treatment during the COVID 19 pandemic in Brazil. Methods/Description: Exploratory and descriptive research with 55 accredited cleft lip and palate treatment centers and partners of an international philanthropic institution. Results: Among the of 55 partners centers (100%), 11% provided essentially multidisciplinary outpatient care and 89% provided surgical procedures besides the outpatient care. In the latter, 100% of the surgeries were postponed but, with the support of the International Philanthropic Institution, the 55 centers continued to provide integral care, including nutrition, speech therapy, social service, dentistry and psychological support to the patients through telemedicine. This online working method has saved lives, such as breastfeeding and proper nutritional counseling for mothers of babies born with the malformation. Doctors from these partner centers have treated thousands of patients remotely, providing vital guidance to families, following up with new patients who were waiting for their surgeries. They also received personal protective equipment (PPE) and essential equipment, such as pulse oximeters and non-contact infrared thermometers, so they could continue to care for patients with clefts, protecting against COVID-19. As government restrictions begin to ease around the world, there is a cautious resumption of free cleft lip and palate surgeries and life-saving outpatient follow-ups. Partner centers are developing safe surgery guidelines in accordance with regulations and recommendations from local and global Medical Advisory Boards allowing for continuity of care and a full and productive life for patients. Conclusions: The COVID-19 pandemic postponed the treatment of many children with cleft lip and palate in Brazil, but gave the partner centers the possibility to study in depth the problems relevant to clinical practice. It was in this context that the International Philanthropic Institution promoted online training with the teams, covering the integral care of the cleft patient, from the first consultation to the surgical treatment and multidisciplinary continuity.
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Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.
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Background/Purpose: The Covid-19 pandemic has restricted in person care at our cleft treatment center, delayed patient turnout, and led to financial losses and an increased number of missed scheduled appointments. Thus, we have sought new ways to monitor the nutritional status of infant patients with clefts, by using the WhatsApp® application, so as to conduct timely nutritional interventions and to prevent malnutrition and anemia. The purpose was to monitor the nutritional status of newborn babies with cleft, using the WhatsApp® application, and to validate its use. Methods/Description: 71% of internet users in Brazil use WhatsApp® to send and receive messages. This application is easy to use, with privacy ensured by cryptography. This research project was approved by the Institutional Review Board. The protocol established: 1) new cases of infants up to 30 days old, with cleft lip and/or cleft palate;2) consent form signed by parent or guardian;3) the first appointment was in person;with mothers receiving training and guidance to send information about their children's height and weight every month;4) data comparisons were conducted against WHO benchmarks (WAZ score between 0 and - 1 = healthy weight;between - 1 and - 2 = nutritional risk;< - 2 = underweight);6) nutritional interventions considering RDI's. Results: 18 patients were followed up by regular data submission through the WhatsApp® application;8 had cleft lips, 3 cleft palates, and 7 cleft lip and palates. Among these patients, 1 had a gastrostomy tube, 2 had cow milk protein allergy, and 1 had cardiac disease. Thus far, 8 have already been submitted to lip surgery, and 10 are waiting to reach the appropriate age for surgery. Twelve were classified as coming from low-income families, and 6 from medium income families. Most of them (no. = 17) travelled between 100-500 km to receive care, and 1 more than 100 km. Eight received transportation and food subsidized by public funds, and 10 used their own funds. Thirteen children were fed breast milk for 120 days, 8 were breast fed directly and 5 were fed pumped breast milk;5 were fed formula. Nine began eating additional foods at 6 months, the remaining patients were not old enough for that yet. Eleven children had normal weight (eutrophic) since the onset, 3 were malnourished when the study began and recovered after about 54 days, 4 were at risk when the study began and recovered after about 26.5 days. No patient had to delay surgery because of anemia (mean Hb = 11.45g/ dL). Nutritional interventions included encouraging breast feeding and different breastfeeding positions, guidance regarding the appropriate concentration of infant formula and how /when to introduce of additional foods. Milk formula, bottles, scales, and measuring tapes were donated. Conclusions: The use of the WhatsApp® application for nutritional follow up proved to be a valid and effective way tomonitor the patients' growth and development, yielding efficient nutritional recovery.