A randomized control trial investigating the effect of presurgical orthopedics on feeding in infants with cleft lip and/or palate.
OBJECTIVE
To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate.


METHODS
Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized.


METHODS
The North Thames Regional Cleft Centre.


METHODS
Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment.


RESULTS
At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: -0.45 (95% confidence interval [-1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [-0.95, 4.91]). None of the differences were statistically significant at either age.


CONCLUSIONS
Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.
Masarei
A G
AG
Great Ormond Street Hospital for Children NHS Trust, London, UK. amsppath@bigpond.net.au
Wade
A
A
Mars
M
M
Sommerlad
B C
BC
Sell
D
D
D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002508:Cephalometry; D002933:Cineradiography; D002971:Cleft Lip / Q000601:surgery / Q000628:therapy*; D002972:Cleft Palate / Q000601:surgery / Q000628:therapy*; D004435:Eating / Q000502:physiology*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009055:Mouth / Q000503:physiopathology; D010158:Palatal Obturators; D021362:Palate, Hard / Q000002:abnormalities; D010160:Palate, Soft / Q000002:abnormalities; D011300:Preoperative Care; D016037:Single-Blind Method; D013391:Sucking Behavior / Q000502:physiology; D016896:Treatment Outcome