A national registry-based study of surgery and demography comparing internationally adopted and children born in Sweden with cleft lip and/or palate

Psychological Screening Indicates That 1 in 4 Children With Cleft Lip and Palate Require Psychological Support

Children with cleft lip and/or palate (CL/P) often experience developmental issues, including language delay, learning difficulties, and attention issues. The aim of the study was to assess potential difficulties in children with CL/P and to determine the necessity of ongoing psychological support. Eighty-two children treated for CL/P, 29 5-year-olds and 53 10-year-olds, participated together with their parents in the study. The Strengths and Difficulties Questionnaire (SDQ) was used to assess difficulties and strengths. Proxy reports were used for the 5-year-olds, while self-reports and proxy reports were utilized for the 10-year-olds. Patients who were identified as requiring further support were offered psychological interventions. Parents of 5-year-olds and 10-year-olds with CL/P estimated significantly more difficulties compared with parents of children in the normal population. Thirty-nine percent of the parents estimated that their child had minor, moderate or severe difficulties. However, 10-year-olds with CL/P didn't perceive any difference in difficulties compared with preadolescents in the normal population. The 10-year-olds estimated significantly less emotional difficulties than children in the normal population. Nevertheless, 41% of the 10-year-olds reported that they overall had difficulties, either minor or severe, in one or more areas. There were significantly moderate correlations between parental and child reports on SDQ. According to the results of the standardized psychological screenings, 25.6% of children with CL/P required additional psychological support. One in 4 children with CL/P needs psychological support. Standardized psychological interview-based follow-ups for patients with CL/P can contribute to more information regarding the patient's needs rather than only using a questionnaire.

Development of software for collecting cleft-specific data in Malaysia

BACKGROUND

The World Health Organization (WHO) has recommended the development of a cleft-specific database for collecting and analyzing data on patients with cleft from birth to adulthood. However, such a database currently does not exist in Malaysia. The objective of this study was to develop a cleft lip and/or palate (CL/P) database software for Malaysia to streamline data collection and support comprehensive research to enhance outcomes of care.

METHODS

The development of the database software involves several key stages, including determining the requirements, designing the software interface, implementing the system, conducting thorough testing, and completing comprehensive documentation. The database software was mainly developed internally within the research institution. The team involved in developing the clinical database includes cleft clinicians, software developers, software designers, members of the Cleft Lip and Palate Association Malaysia (CLAPAM), and experts in database development.

RESULTS

An online and offline database software has been developed to store information on patients with CL/P in Malaysia. It is designed to be user-friendly, accommodating multiple specialties and capable of storing photographs, radiology, and three-dimensional files. Various methods have been implemented to ensure data security. Additionally, documentation including video tutorials, consent forms, and hard copy versions has been developed to complement the database.

CONCLUSION

A specialized cleft-specific database software has been successfully developed for use in Malaysia to improve data management and support CL/P patient care.

Foreign-born 5-year-old children with cleft palate had poorer speech outcomes than their native-born peers

AIM

Speech difficulties are common in children with cleft palate, but research on foreign-born children is limited. This study aimed to compare speech outcomes, surgery and speech intervention in 5-year-old foreign-born and Swedish-born children with cleft palate with or without cleft lip.

METHODS

This retrospective study analysed data from the Swedish cleft lip and palate registry for children born between 2009 and 2016 using Pearson's Chi-squared test and binary logistic regression.

RESULTS

Among 160 foreign-born (106 boys, 54 girls) and 847 Swedish-born (479 boys, 368 girls) 5-year-olds, foreign-born children had significantly lower rates of sufficient velopharyngeal competence (77% vs. 86%), age-appropriate consonant production (28% vs. 60%), and speech without non-oral speech errors (70% vs. 86%). Differences remained after adjustment for cleft type, gender and additional diagnosed conditions. After further adjustments for age at completed primary palatal surgery, differences in age-appropriate consonant production and speech without non-oral speech errors remained significant. Foreign-born children underwent completed primary palatal surgery at older ages and received more secondary palatal surgery and speech intervention than Swedish-born peers.

CONCLUSION

Foreign-born children showed poorer speech outcomes than Swedish-born peers, despite more secondary palatal surgery and speech intervention. Age at completed primary palatal surgery could partly explain these differences.

Craniofacial Growth in Children With Unilateral Cleft Lip and Palate: Adopted From China Versus Born in Sweden

OBJECTIVE

In 2005, the number of internationally adopted children (IAC) with cleft lip and palate (CLP) from China increased globally, followed by an increase in the number of surgical complications. The aim was therefore to evaluate the craniofacial growth of children with unilateral CLP adopted from China and compare with non-adopted peers (NA).

METHODS

Cephalograms taken at 10 and 13 were analysed for the SNA, SNB, ANB, NAPg and NSBa angles. Surgical data were extracted from the medical records.

RESULTS

The rate of secondary cleft-related surgery including secondary alveolar bone grafting (SABG) was higher in the IAC group than in the native groups. At age 10, the IAC exhibited higher SNB and NAPg and lower ANB values than the NA-Mod group and a similar pattern was observed at age 13. The IAC group demonstrated significantly lower SNA and ANB and higher NAPg values than the NA-Orig group at age 10. At age 13, lower SNA and ANB and higher SNB, NAPg, and NSBa values were observed in the IAC group compared with the NA-Orig group.

LIMITATIONS

Craniofacial growth is not finalized at age 13 years, why additional studies are needed to determine long-term outcomes.

CONCLUSIONS

Results from this novel study present unfavorable craniofacial growth at age 10 and 13 years of age among IAC with UCLP and indicate an increased need for future orthognathic surgery compared with NA peers.

Ethical Challenges for Plastic Surgery in Treating Internationally Adopted Children With Cleft Lip and Palate

A large number of children with cleft lip and palate (CLP) were adopted to Sweden in the last decade, mainly from China. Most of the children arrived with unoperated palates and at later ages than earlier years. This article aims to present an overview of ethical challenges within the practice of international adoption of children with CLP from the perspective of plastic surgery in a welfare health care system. An overview of CLP treatment is presented, followed by a normative discussion and ethical analysis using the 4 principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. The following themes and subthemes were analyzed: the search for normality and the potential challenge of being adopted and having CLP-treatment autonomy of the child and future preferences, adoptive parents' expectations of plastic surgery, the journey of the adoptee and the adoptive parents; and general issues-reconstructive possibilities and consequences of CLP in the country of origin, information to the adoptive parents, health care needs, and reconstructive possibilities for children with CLP in the receiving country. Clinical implications are discussed, and suggestions for future research are provided.

Comment on Ombashi, van der Goes, Versnel, Khonsari, van der Molen: guidance to develop a multidisciplinary, international, pediatric registry: a systematic review, Orphanet Journal of Rare diseases, 2023

Recently, Ombashi et al. published a systematic review aiming to identify the pitfalls in the development and implementation as well as factors influencing long-term success of a multidisciplinary, international registry for cleft care on a global scale. The purpose of this letter to the editor is to highlight that the review failed to include the Swedish quality registry for patients born with cleft lip and palate, which fulfils the inclusion criteria. The Swedish cleft lip and palate registry is multidisciplinary, has a high coverage and reporting degree, and most outcome measures have been checked for reliability and validity. It is regularly used for open comparisons between treatment centers. Several research studies have been published based on the Swedish cleft lip and palate registry, and more are ongoing. The information we provide about the Swedish cleft lip and palate registry complements and expands the information of the results reported by Ombashi et al. in their research.