Perinatal Airway Risk for Individuals With Isolated Cleft Spectrum

Abstract

ObjectiveCleft spectrum anomalies are sometimes associated with airway obstruction at birth. Modified delivery may facilitate advanced treatment, but there is insufficient data examining its use in patients with isolated cleft lip (iCL), isolated cleft palate (iCP), or cleft lip and palate (CLP). This study aims to address this gap.DesignDeidentified birth hospitalization data were extracted from the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000-2019). Patients were identified using ICD codes and categorized as iCL, iCP, and CLP. Incidence, demographics, airway procedures on day of life (DOL) 0 or 1, complications, and survival were examined. The Rao-Scott chi-square test was used for comparison between unaffected and cleft spectrum groups.ParticipantsThe sample included 26 943 508 individuals, excluding out-of-hospital births, transfers, and individuals with cleft in association with mandibular anomalies or syndromic disorders.ResultsThe weighted incidence for isolated cleft spectrum was 1.3 per 1000 birth visits. Airway intervention on DOL 0 or 1 occurred in 5.0% of the cleft group compared to 1.7% in the unaffected group (P ≤ .01). Preterm delivery occurred more frequently among patients with cleft spectrum but did not account for the elevated rate of airway intervention. Among individuals who received an airway intervention, hypoxic complications or mortality were more frequent in patients with cleft spectrum.ConclusionsIndividuals with isolated cleft spectrum experience higher rates of perinatal airway interventions with poorer outcomes than unaffected individuals. These findings may affect delivery planning, especially regarding the location and availability of neonatal services at delivery.

Keywords: airway obstruction; cleft lip; cleft lip and palate; cleft palate; intervention; pediatrics; upper airway obstruction.