title: Elevated Infant Mortality Rate among Dutch Oral Cleft Cases: A Retrospective Analysis from 1997 to 2011.
abstract: OBJECTIVE
  First, to determine the infant mortality rate (IMR) for Dutch patients with isolated oral clefts (OC) as well as for patients with clefts seen in association with other malformations. Second, to conduct a similar analysis per cleft type: cleft lip with or without cleft palate (CP), CP (including Robin sequence). Third, to examine the underlying causes of death.
  
  
  METHODS
  A retrospective review of the charts of patients with OC born in the period 1997-2011 and treated in three regional cleft centers in the Netherlands.
  
  
  RESULTS
  One thousand five hundred thirty patients with OC were born during the study period and treated in the cleft centers. The overall IMR for all clefts was 2.09%, significantly higher than the general Dutch IMR of 0.45%. In a subanalysis per cleft type, the IMRs were 1.22, 1.38, 2.45, and 3.62% for cleft lip, cleft lip with CP, CP, and Robin sequence, respectively. The mortality rates for isolated OC did not differ significantly from the general Dutch rate. Causes of death were congenital malformations of the heart in 40.6%, airway/lungs in 15.6%, nervous system in 15.6%, infectious disease in 12.5%, and other or unknown in 15.6%.
  
  
  CONCLUSIONS
  The elevated IMR observed in Dutch patients with OC is almost exclusively caused by associated congenital malformations. After diagnosis of an oral cleft an in-depth medical examination and a consult by the pediatrician and clinical geneticist is imperative to instigate the appropriate medical management.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Daan P F
authors.initials: DP
authors.lastname: van Nunen
authors.affiliation: Department of Medical Genetics, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Marie-José H
authors.initials: MJ
authors.lastname: van den Boogaard
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Vrije Universiteit University Medical Center Amsterdam , Amsterdam , Netherlands.
authors.forename: J Peter W
authors.initials: JP
authors.lastname: Don Griot
authors.affiliation: Department of Plastic Surgery, University Medical Center Groningen , Groningen , Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: Rüttermann
authors.affiliation: Department of Medical Genetics, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Lars T
authors.initials: LT
authors.lastname: van der Veken
authors.affiliation: Division of Plastic and Reconstructive Surgery, University Medical Center Utrecht , Utrecht , Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
keywords: Netherlands; Pierre Robin syndrome; Robin sequence; cleft lip; cleft palate; epidemiology; infant mortality