title: Late detection of cleft palate.
abstract: Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of this study is to retrospectively investigate (1) at which age CPO is diagnosed and (2) how the presence of syndromes and other factors relate to the age at diagnosis. The mean age of all children at our centre with CPO included between 1997 and 2014 at diagnosis (n = 271) was 1 year and 4 months. In all, 24.8% (n = 67) was older than 12 months when diagnosed, and 37.3% (n = 101) of all children had been diagnosed >30 days. These findings remain valid when a cut-off point of 14 days is used (44.3% late). Moreover, the grade of the cleft was a determining factor for successful diagnosis; submucous clefts were detected much later on average (89.3% > 30 days; p = .000). Similar results were found using Kaplan-Meier survival analyses.
  
  
  CONCLUSIONS
  CPO is often diagnosed late. Patients diagnosed ≤30 days after birth more often presented with an associated disorder. Early diagnoses became more frequent as the severity of the cleft increased (grades 1-4). Professionals should perform more thorough intra-oral investigations, including manual palpations and visual inspections of the palate; they should be made more aware of the frequent accompanying symptoms.
  
  
  BACKGROUND
  The presence of cleft palate only (CPO) is known to negatively affect feeding, hearing, speech and (social) development. Submucous clefts are often underdiagnosed due to their difficulty to detect. As far as we know the literature shows that symptomatic submucous CPs are often diagnosed at an average age of 4.9 years.
  
  
  BACKGROUND
  37.3% respectively of all children with CPO were diagnosed relatively late (>30 days after birth), 24.8% was older than 12 months when diagnosed. Mean age of all children with CPO was 1 year and 4 months. We conclude that midwives and pediatricians should perform more through intra-oral investigations of all new-borns, including both a manual palpation, als well a visual inspection of the palate.
authors.affiliation: Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: K H
authors.initials: KH
authors.lastname: Hanny
authors.affiliation: Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands. i.a.c.devries-5@umcutrecht.nl.
authors.forename: I A C
authors.initials: IA
authors.lastname: de Vries
authors.affiliation: Department of Speech and Language Therapy, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Haverkamp
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
authors.forename: K P Q
authors.initials: KP
authors.lastname: Oomen
authors.affiliation: Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Penris
authors.affiliation: Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands.
authors.forename: M J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.affiliation: Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kon
authors.affiliation: Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: Mink van der Molen
authors.affiliation: Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D000367:Age Factors; D002972:Cleft Palate / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Age; Children; Cleft palate only; Diagnosis; Feeding difficulties; Nasal regurgitation