Growth trajectories in children with cleft lip and/or palate / Trayectorias de crecimiento en niños con fisura labial y/o palatina

Introduction: the nutritional status and growth of children with cleft lip and/or palate (CL/P) can be affected due to feeding difficulties caused by their anatomy and the surgical interventions. Objective: this retrospective longitudinal study aims to analyse the growth trajectories of a cohort of children with CL/P and compare them with a healthy representative cohort of children from Aragon (Spain). Methods: type of cleft, surgical technique and sequelae, and weight, length/height and body mass index (BMI) (weight/height2) at different ages (0-6 years) were recorded. Normalized age- and sex-specific anthropometric Z-scores values were calculated by World Health Organization (WHO) charts. Results: forty-one patients (21 male, 20 female) were finally included: 9.75 % cleft lip (n = 4/41), 41.46 % cleft palate (n = 17/41) and 48.78 % cleft lip and palate (n = 20/41). The worst nutritional status Z-scores were achieved at the age of three months (44.44 % and 50 % had a weight and a BMI lower than -1 Z-score, respectively). Mean weight and BMI Z-scores were both significantly lower than controls at one, three and six months of age, recovering from that moment until the age of one year. Conclusions: the highest nutritional risk in CL/P patients takes place at 3-6 months of age, but nutritional status and growth trajectories get recovered from one year of age compared to their counterparts. Nevertheless, the rate of thin subjects among CL/P patients is higher during childhood.(AU)

Introducción: el estado nutricional y el crecimiento de los niños con labio y/o paladar fisurado (CL/P) pueden verse afectados debido a lasdificultades de alimentación provocadas por su anatomía y las intervenciones quirúrgicas.Objetivo: este estudio longitudinal retrospectivo tiene como objetivo analizar las trayectorias de crecimiento de una cohorte de niños con CL/Py compararlos con una cohorte representativa de niños sanos de Aragón (España).Métodos: se registraron el tipo de fisura, la técnica quirúrgica y las secuelas, el peso, la longitud/talla y el índice de masa corporal (IMC) (peso/talla2) a diferentes edades (0-6 años). Se calcularon las Z-score de los valores antropométricos según edad y sexo, mediante las tablas de laOrganización Mundial de la Salud (OMS).Resultados: se incluyeron 41 pacientes (21 hombres, 20 mujeres): 9,75 % con fisura labial (n = 4/41), 41,46 % con fisura palatina (n = 17/41)y 48,78 % con fisura labiopalatina (n = 20/41). Los valores Z-scores de la antropometría más bajos se alcanzaron a los tres meses de edad (el44,44 % y el 50 % tenían un peso y un IMC inferiores a -1 Z-score, respectivamente). Los valores de peso medio y de las puntuaciones Z delIMC fueron significativamente más bajos en los pacientes con fisura que en los controles a los uno, tres y seis meses de edad, recuperándosea partir de ese momento hasta equipararse al año de edad.Conclusiones: el mayor riesgo nutricional en pacientes con CL/P se presenta entre los tres y seis meses de edad, pero su estado nutricionaly las trayectorias de crecimiento se normalizan a partir del año de edad. Sin embargo, la proporción de individuos delgados entre los pacientescon CL/P es mayor durante la infancia.(AU)

Maternal periconceptional folic acid supplementation reduced risks of non-syndromic oral clefts in offspring.

Maternal periconceptional folic acid supplementation (FAS) has been documented to be associated with decreased risk of nonsyndromic oral clefts (NsOC). However, the results remain inconclusive. In this population-based case-control study of 807 singletons affected by NsOC and 8070 healthy neonates who were born between October 2010 and September 2015 in Chengdu, China, we examined the association of maternal FAS with the risk of nonsyndromic cleft lip with or without cleft palate (NsCL/P), and cleft palate (NsCP). Unconditional logistic regression analysis was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidential intervals (CI). Significant associations were found between maternal periconceptional FAS and decreased risk of NsCL/P (aOR = 0.41, 95% CI 0.33-0.51). This protective effect was also detected for NsCL (aOR = 0.42, 95% CI 0.30-0.58) and NsCLP (aOR = 0.41, 95% CI 0.31-0.54). Both maternal FAS started before and after the last menstrual period (LMP) were inversely associated with NsCL/P (before LMP, aOR = 0.43, 95% CI 0.33-0.56; after LMP, aOR = 0.41, 95% CI 0.33-0.51). The association between NsCP and maternal FAS initiating before LMP was also found (aOR = 0.52, 95% CI 0.30-0.90). The findings suggest that maternal periconceptional FAS can reduce the risk of each subtype of NsCL/P in offspring, while the potential effect on NsCP needs further investigations.

Long-term growth patterns in children born with cleft lip and/or palate. A systematic review / Patrones de crecimiento a largo plazo en niños nacidos con fisura labial y/o palatina. Una revisión sistemática

INTRODUCTION: in children with cleft lip and/or palate nutritional status and growth may be impaired due to early life feeding difficulties. OBJECTIVE: to review the existing literature on the nutritional prognosis during childhood of patients undergoing surgery for cleft lip and/or palate (CLP), their body composition and growth patterns from 2 to 10 years of age, and the possible effects of their early nutritional status on the long-term onset of overweight. METHODS: a systematic search of growth and body composition parameters in 2-10 year-old CLP children, including cross-sectional and longitudinal studies, and using the Pubmed and Scopus databases. From the 2,983 retrieved articles, 6 were finally included. RESULTS: two studies out of 6 were longitudinal and the other 4 were cross-sectional, including very heterogeneous samples. Weight and height were used as growth parameters in 2 studies; 2 studies used body mass index (BMI); and the remaining 2 used indexes of nutritional status derived from anthropometric measures. The studies showed discrepancies among results: 3 of them found growth differences between children with CLP and their counterparts, whereas the other 3 did not. The two longitudinal studies did not show any significant differences between the mean BMI z-scores or growth curves of cleft patients and their counterparts. When differences existed, the most affected group was that under 5 years, syndromic children, and adopted children with CL/P. CONCLUSIONS: the literature is scarce comparing growth patterns between children with CLP and controls, and results cannot confirm that children with CLP aged 2-10 years, excluding those with syndromes or belonging to vulnerable populations, have different growth patterns or a worse nutritional status than their counterparts

INTRODUCCIÓN: en niños con fisura labial y/o palatina, el estado nutricional y el crecimiento pueden verse afectados debido a dificultades en la alimentación. OBJETIVOS: revisar el pronóstico nutricional de pacientes sometidos a cirugía de fisura labiopalatina (FLP), su composición corporal y sus patrones de crecimiento de los 2 a los 10 años, así como los posibles efectos del estado nutricional durante la primera infancia sobre la aparición posterior de sobrepeso. MÉTODOS: búsqueda sistemática de parámetros de crecimiento y composición corporal en niños con CLP de 2 a 10 años, incluyendo estudios transversales y longitudinales en las bases de datos Pubmed y Scopus. De los 2983 artículos potencialmente relevantes, 6 fueron finalmente incluidos. RESULTADOS: dos estudios de 6 fueron longitudinales y los otros 4, transversales, con muestras muy heterogéneas. El peso y la altura se utilizaron como parámetros de crecimiento en 2 estudios; 2 estudios utilizaron el índice de masa corporal (IMC), y los otros 2, índices del estado nutricional a partir de medidas antropométricas. Los estudios mostraron discrepancias entre los resultados: 3 de ellos encontraron diferencias de crecimiento entre los niños con CLP y sus coetáneos, mientras que los otros 3, no las encontraron. Los dos estudios longitudinales no mostraron diferencias significativas entre el IMC (z-score) ni entre las curvas de crecimiento de los pacientes con FLP y sus coetáneos. Cuando existían diferencias, el grupo más afectado fue el de los menores de 5 años, niños sindrómicos y niños adoptados con CL/P. CONCLUSIONES: la literatura sobre los patrones de crecimiento de los niños con CLP es escasa y los resultados no pueden confirmar que los niños con CLP de 2 a 10 años, excluyendo aquellos con síndromes o pertenecientes a poblaciones vulnerables, tengan patrones de crecimiento diferentes o un peor estado nutricional que sus coetáneos

Práticas alimentares de crianças menores de três anos de uma creche particular da cidade de Fortaleza/Brasil / Food practices of children under three years old of a day care school creche of the city of Fortaleza/Brasil

Objetivo: Caracterizar as práticas alimentares de crianças menores de três anos de uma creche particular da cidade de fortaleza (CE). Métodos: Realizou-se um estudo transversal, com 84 crianças menores de três anos, de ambos os sexos em uma creche de Fortaleza (CE/Brasil). Para a investigação sobre as práticas alimentares, foi utilizado um formulário padrão da creche de anamnese alimentar, preenchido pelos pais no momento da matrícula contendo informações sobre aleitamento materno, alimentação complementar e utensílios utilizados para a alimentação. Utilizou-se o teste de Shapiro Wilk para testar a normalidade das variáveis; e para se investigar a associação entre elas, foram utilizados os testes do Qui-quadrado ou Exato de Fischer. Resultados: Foi verificada amamentação total por menos de seis meses em 42,3% das crianças e por mais de doze meses, apenas 11,5%. Quanto ao aleitamento materno exclusivo, apenas 36,8% completou os seis meses como preconizado pela OMS e os outros 63,2% da população estudada tiveram o aleitamento exclusivo interrompido precocemente. Foi verificada uma grande prevalência do uso de mamadeira (86,9%) nas crianças estudadas. Conclusão: O aleitamento materno exclusivo e total foi aquém do recomendado pela literatura. Apesar de se ter verificado práticas alimentares adequadas quanto à qualidade das preparações, com a oferta de comida de panela, fruta, legumes e verduras (AU)

Objective: To characterize the feeding practices of children under three years of a private da care center in the city of Fortaleza (CE). Methods: A cross-sectional study was carried out with 84 children under three years old, of both genders in a day care center in Fortaleza (CE / Brazil). For the research on feeding practices, a standard form of food anchnes day care was used, filled out by the parents at the time of enrollment, containing information on breastfeeding, complementary feeding and utensils used for feeding. The Shapiro Wilk test was used to test the normality of the variables; and to investigate the association between them, Chi-square or Fischer's exact tests were used. Results: Total breastfeeding was observed for less than six months in 42.3% of the children and for more than twelve months, only 11.5%. Regarding exclusive breastfeeding, only 36.8% completed the six months as recommended by the WHO and the other 63.2% of the population studied had exclusive breastfeeding interrupted early. There was a high prevalence of bottle-feeding (86.9%). Conclusion: Exclusive and total breastfeeding was lower than recommended in the literature. Despite the existence of adequate food practices regarding the quality of the preparations, with the supply of pot food, fruits and vegetables (AU)

Práticas alimentares e estado nutricional de crianças menores de 2 anos com fissura labial e palatal / Food practices and nutritional status of children under 2 years with cleft lip and palatal fissure

Objetivo: el objetivo de este estudio fue verificar las prácticas alimentarias y el estado nutricional de niños menores de 2 años con fisura de labio y / o paladar. Métodos: Se realizó un estudio observacional descriptivo cuantitativo que empleó un cuestionario para evaluar el tipo de fisura presentada, edad, género y prácticas alimentarias previas y actuales del niño fisurado. El estado nutricional fue evaluado por medio de índices antropométricos. Resultados: participaron en este estúdio 22 niños con fisuras de labio y / o paladar con una media de edad de 8 ± 6 meses. Los tipos de fisuras más frecuentes observadas fueron la fisura del tipo palatina post-forame (n = 6, 27%) y la transforme incisiva unilateral (n = 6, 27%). Sólo un (4%) niño fue amamantado exclusivamente hasta los seis meses. Las dificultades alimentarias encontradas fueron reflujo nasal (n = 3, 14%), engaños (n = 3, 14%) y succión insuficiente (n = 1, 4%). Se observó uso de biberón, vaso y cuchara en 12 (54%) niños, uso de boquillas ortodónticas en 8 (36%) niños y hábito de ofrecer alimentos amasados en 5 niños (23%) con introducción alimentaria presente. Un pequeño porcentaje de niños reciben alimentos licuados (n = 2, 9%). Eutrofia según el Índice de Masa Corporal/edad se verificó en 16 (73%) niños. Conclusión: se observó baja frecuencia de alimentación exclusiva con leche materna hasta los seis meses de edad, utilización de biberones con boquillas ortodónticas, consumo de alimentos amasados y adecuado estado nutricional en la mayoría de los niños estudiados (AU)

Objective: The purpose of this study was to check dietary practices and the nutritional status of children younger than 2 years with cleft lip and/or palate. Methods: A quantitative descriptive observational study was carried out, using a questionnaire to evaluate the type of cleft present, age, gender and past and present eating practices of the fissured child. The nutritional status was evaluated through anthropometric indices. Results: were participate of this study 22 children with clefts of lip and/or palate with man age of 8 ± 6 months. The most frequent types of cleft observed were post-foramen cleft (n=6, 2.7%) and unilateral incisor (n=6, 2.7%). Only one (4%) child was exclusively breastfed until six months. The feeding difficulties were nasal reflux (n=3, 14%), gagging (n=3, 14%) and insufficient sucking (n=1, 4%). The use of bottle, cup and spoon was observed in 12 (54%) children, use of orthodontic nozzles in 8 (36%) children and the habit of offering crushed food in 5 children (23%) with present food introduction. Small percentage of children receive liquidated food (n = 2, 9%). Eutrophy according to the Body Mass Index/age was verified in 16 (73%) children. Conclusion: we observed low frequency of exclusive feeding with breast milk up to six months of age, use of bottles with orthodontic nozzles, consumption of crushed and adequate nutritional status in the majority of the children studied (AU)

Atuação fonoaudiológica na Unidade De Terapia Intensiva em bebê com síndrome de pterígeo poplíteo / Speech-language therapy at the Neonatal Intensive Care Unit with a baby with popliteal pterygium syndrome

O objetivo deste estudo foi descrever a intervenção fonoaudiológica para a adequação da função alimentar por meio da avaliação e tratamento do sistema estomatognático e suas funções. O estudo foi feito a partir do relato de caso de um recém-nascido portador da Síndrome de Pterígio Poplíteo, que foi alimentado por sonda, atendido na Unidade de Tratamento Intensivo Neonatal. A avaliação fonoaudiológica apresentou os seguintes resultados: mandíbula retraída com pouca abertura, gengivas superiores e inferiores hipertróficas, palato com fissura pós-forame incisivo incompleta, reflexos orais de alimentação (busca, sucção, deglutição) presentes e adequados; reflexos de defesa (mordida, gag) anteriorizados e exacerbados. Apresentou pouca tolerância ao toque intra-oral. A sucção não nutritiva teve como resultado um número de sucções/pausas de 3:1, com ritmo presente, com força débil. Na sucção nutritiva, por meio da mamadeira, apresentou sucções/pausa de 5:1, com pausas longas. Foram observados sinais de estresse de alteração respiratória, estridor inspiratório leve, um episódio de engasgo e reflexo de gag anteriorizado e exacerbado, demonstrando hipersensibilidade oral em resposta ao bico convencional da mamadeira. Foram realizadas cinco sessões de intervenção fonoaudiológica, com orientações para a mãe e a equipe de enfermagem sobre postura, estimulação oral e uso de bico ortodôntico. O recém-nascido teve alta com via oral plena e com bom ganho de peso.

The aim of this study was to describe the speech-language intervention for the adequacy of the alimentary function through assessment and treatment of the stomatognathic system and its functions. The study was carried out based on the case report of a newborn with popliteal pterygium syndrome, fed by tube while taken care of at the Neonatal Intensive Care Unit (NICU). The speech-language assessment presented the following results: retracted jaw with little opening, hypertrofic inferior and superior gums, incomplete cleft palate, present and adequate oral reflexes (search, sucking, swallowing), anterior trigger of the gag reflex and overactive bite reflex. The oral sensitiveness was impaired. The non-nutritive sucking resulted in a ratio of 3:1 sucks per burst, with rhythm, but weak. In the nutritive sucking with a bottle, the newborn presented a 5:1 sucks per burst ratio, with long pauses. Signs of stress were observed, with breathing alteration, mild inspiratory stridor, a choking episode, and anterior and overactive gag reflex, demonstrating oral hypersensitivity in response to the use of a conventional bottle teat. Five weekly sessions of speech-language therapy were carried out, with orientations to the mother and the nursing team regarding position, oral stimulation and use of orthodontic bottle teats. The newborn was discharged with full oral feeding and good weight gain.

Effectiveness of two feeding methods in improving energy intake and growth of infants with cleft palate: a randomized study.

OBJECTIVE: To compare two feeding methods advocated for infants with cleft palate: (a) a squeezable plastic container with a narrow, long crosscut nipple (squeezable cleft palate nurser); and (b) a standard nipple with a crosscut (crosscut nipple). The effectiveness of a nutrition intervention protocol for these infants was also documented. DESIGN: Thirty-one infants (median age = 15 days) were randomized to one of two feeding methods (18 infants, squeezable cleft lip/palate nurser; 13 infants, crosscut nipple) within sex (21 boys, 10 girls) and palatal defect (22 cleft lip and palate, 9 isolated cleft palate) categories. The intervention included feeding technique instructions, nutrition counseling at each clinic visit, use of the same 20 kcal/oz standard formula for 12 months, and introduction of infant and soft table foods at 6 months. Four-day food records and growth data were obtained. MAIN OUTCOME MEASURES: Mean energy and protein intakes at 3 and 6 months of age and growth measurements during the first 18 months of life were obtained. STATISTICAL ANALYSES: A repeated measures analysis of variance for intakes was performed with time as the repeated measure and feeding method as the covariable. Similar analyses were completed for growth measures with sex and feeding method as covariates. RESULTS: Mean energy intake at 3 and 6 months of age (P = .24) and growth measurements during the first 18 months of life (P values: weight gain [grams per day], .73; weight, .21; length, .07; head circumference, .18; triceps and subscapular skinfolds and mid-arm circumference, .47, .48, and .69, respectively) were not significantly different. Both feeding methods were effective in supporting normal growth. APPLICATIONS: With adequate instruction related to the use of either feeding technique and close nutrition follow-up early in infancy, a dietitian or other health care practitioner may advise the use of either feeding method. These data support the need for feeding and nutrition education and early nutrition intervention.