Delayed detection of cleft palate: an audit of newborn examination.
OBJECTIVE
To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination.


METHODS
Audit of hospital notes, parental questionnaire incorporating open ended questions, and telephone questionnaire of junior doctors in the referring hospitals incorporating fixed choice questions.


RESULTS
Of 344 cleft palate patients without cleft lip or submucous cleft palate, the day the cleft was detected was recorded in 92%. Delayed detection, after the first day, was 28% overall, distributed as 37% with isolated cleft palate and 23% with syndromic cleft palate. Narrow V shaped clefts were more likely to be delayed in detection compared with broad U shaped clefts, as were soft palate clefts compared with hard palate clefts. Five with isolated cleft palates were not detected until after the first year. Babies born at home were unlikely to be detected on day 1. Symptoms were significantly increased in the delayed detection group for feeding problems and nasal regurgitation. A telephone questionnaire of trainee paediatricians in referring units revealed that digital examination was more commonly practised than visual inspection, and few recalled receiving specific instruction on examination of the palate.


CONCLUSIONS
Delayed detection of cleft palate was not uncommon, and the features of those more likely to be missed suggested digital examination was related. Trainee doctors and midwives should be instructed to inspect visually using a light and tongue depressor, then digitally if submucous cleft palate is suspected.
Habel
A
A
North Thames Cleft Lip and Palate Centre, Great Ormond Street Hospital for Children, UK. alex.habel@btinternet.com
Elhadi
N
N
Sommerlad
B
B
Powell
J
J
D000015:Abnormalities, Multiple / Q000175:diagnosis; D000367:Age Factors; D002972:Cleft Palate / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards; D015997:Neonatal Screening / Q000379:methods / Q000592:standards*; D010808:Physical Examination / Q000379:methods / Q000592:standards