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Wenger TL, Perkins J, Parish-Morris J, Hing AV, Chen ML, Cielo CM, Li D, Bhoj EJ, Hakonarson H, Zackai E, McDonald-McGinn DM, Taylor JA, Jackson O, Sie K, Bly R, Dahl J, Evans KN. Cleft palate morphology, genetic etiology, and risk of mortality in infants with Robin sequence. Am J Med Genet A 2021; 185:3694-3700. [PMID: 34291880 DOI: 10.1002/ajmg.a.62430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/26/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022]
Abstract
Robin sequence (RS) has many genetic and nongenetic causes, including isolated Robin sequence (iRS), Stickler syndrome (SS), and other syndromes (SyndRS). The purpose of this study was to determine if the presence and type of cleft palate varies between etiologic groups. A secondary endpoint was to determine the relationship of etiologic group, cleft type, and mortality. Retrospective chart review of patients with RS at two high-volume craniofacial centers. 295 patients with RS identified. CP was identified in 97% with iRS, 95% with SS, and 70% of those with SyndRS (p < .0001). U-shaped CP was seen in 86% of iRS, 82% with SS, but only 27% with SyndRS (p < .0001). At one institution, 12 children (6%) with RS died, all from the SyndRS group (p < .0001). All died due to medical comorbidities related to their syndrome. Only 25% of children who died had a U-shaped CP. The most common palatal morphology among those who died was an intact palate. U-shaped CP was most strongly associated with iRS and SS, and with a lower risk of mortality. RS with submucous CP, cleft lip and palate or intact palate was strongly suggestive of an underlying genetic syndrome and higher risk of mortality.
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Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan Perkins
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Julia Parish-Morris
- Division of Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne V Hing
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Maida L Chen
- Division of Pulmonary Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Christopher M Cielo
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hakon Hakonarson
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elaine Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Donna M McDonald-McGinn
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse A Taylor
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Oksana Jackson
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Sie
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Randall Bly
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - John Dahl
- Division of Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kelly N Evans
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, WA, USA
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Yow M, Jin A, Yeo GSH. Epidemiologic trends of infants with orofacial clefts in a multiethnic country: a retrospective population-based study. Sci Rep 2021; 11:7556. [PMID: 33824370 PMCID: PMC8024282 DOI: 10.1038/s41598-021-87229-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/23/2021] [Indexed: 11/08/2022] Open
Abstract
Cleft births surveillance is essential in healthcare and prevention planning. Data are needed in precision medicine to target upstream management for at-risk individuals. This study characterizes Singapore's population-based orofacial cleft topography by ethnicity and gender, and establishes the cleft cohort's infant mortality rate. Data, in the decade 2003 to 2012, were extracted by the National Birth Defects Registry. Trend testing by linear regression was at p < 0.05 significance level. Prevalence per 10,000 for population-based cleft live births was 16.72 with no significant upward trend (p = 0.317). Prevalence rates were 8.77 in the isolated cleft group, 7.04 in the non-isolated cleft group, and 0.91 in the syndromic cleft group. There was significant upward trend in infants with non-isolated clefts (p = 0.0287). There were no significant upward trends in infants with isolated clefts and syndromic clefts. Prevalence rates were sexually dimorphic and ethnic-specific: male 17.72; female 15.78; Chinese group 17.17; Malay group 16.92; Indian group 10.74; and mixed ethnic origins group 21.73. The overall infant mortality rate (IMR) was 4.8% in the cohort of 608 cleft births, which was more than double the population-based IMR of 2.1% in the same period. Infants with non-isolated and syndromic clefts accounted for 96.6% of the deaths.
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Affiliation(s)
- Mimi Yow
- Department of Orthodontics, National Dental Centre Singapore, Second Hospital Avenue, Singapore, 168938, Singapore.
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Sweden.
| | - Aizhen Jin
- Centre for Healthy Longevity, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore
| | - George Seow Heong Yeo
- Department of Maternal and Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Malic CC, Lam M, Donelle J, Richard L, Vigod SN, Benchimol EI. Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada. JAMA Netw Open 2020; 3:e1921036. [PMID: 32049294 DOI: 10.1001/jamanetworkopen.2019.21036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality. RESULTS From 1994 to 2017, 3262 children were born with OFC in Ontario, Canada, and they were matched to 15 222 children born without OFC. Incidence of OFC in Ontario was 1.12 cases per 1000 live births, with wide geographic variation and a lower incidence from 2004 to 2017 compared with 1994 to 2003 (1.02 vs 1.13 cases per 1000 live births; P = .002), especially for the subgroup with cleft palate (0.52 vs 0.44 cases per 1000 live births; P = .006). Children with OFC, compared with children without OFC, were more likely to be born prematurely (406 children [13.3%] vs 1086 children [7.1%]; P < .001; standardized difference, 0.21) and had lower mean (SD) birth weight (3215.3 [687.6] g vs 3382.6 [580.0] g; P < .001; standardized difference, 0.26). The mortality rate among children with OFC was higher than among matched children without OFC (hazard ratio, 10.60; 95% CI, 7.79-14.44; P < .001). When mortality was adjusted for the presence of congenital or chromosomal anomalies, the risk of death was not significantly different between children with OFC and those without OFC (hazard ratio, 1.35; 95% CI, 0.73-2.72). CONCLUSIONS AND RELEVANCE These findings suggest that incidence of OFC In Ontario, Canada, decreased from 1994 to 2017. Mortality in children with OFC was high, especially in the first 2 years of life, and was predominantly associated with the presence of other congenital or chromosomal anomalies. Further research is required to better understand the causes of wide geographical variations of OFC incidence and improve the survival of these patients.
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Affiliation(s)
- Claudia C Malic
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Jessy Donelle
- ICES uOttawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Simone N Vigod
- Division of Equity, Gender and Population, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's Mental Health Research, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eric I Benchimol
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Pediatrics, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Health Information Technology Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Gabrielli S, Piva M, Ghi T, Perolo A, De Santis MSN, Bevini M, Bonasoni P, Santini D, Rizzo N, Pilu G. Bilateral cleft lip and palate without premaxillary protrusion is associated with lethal aneuploidies. Ultrasound Obstet Gynecol 2009; 34:416-418. [PMID: 19697393 DOI: 10.1002/uog.6451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the clinical implications of two categories of fetal bilateral cleft lip and palate (BCLP): with premaxillary protrusion and with a flattened profile. METHODS This was a retrospective study of fetuses with a prenatal diagnosis of BCLP at the Department of Obstetrics and Gynecology of the University of Bologna in the period 1991-2005. RESULTS BCLP was diagnosed prenatally in 14 cases (mean gestational age at diagnosis, 21 (range, 12-36) weeks). In nine of these, there was a premaxillary pseudomass; in the remaining five, the profile was flat. Associated structural and/or chromosomal anomalies were found in two of the nine with a premaxillary pseudomass and in all five of those with a flat profile (P = 0.02). All fetuses with a flat profile had aneuploidies (three trisomy 18, one trisomy 13, one trisomy 8 mosaic), as did one of the nine with a premaxillary pseudomass. Eight of the pregnancies were terminated, including three of those with a premaxillary pseudomass and all five of those without. All continuing pregnancies resulted in live births, although one neonate affected by Krabbe's disease died shortly after birth. CONCLUSIONS Our findings suggest that a third of cases of BCLP diagnosed in utero have a flat profile and these are at high risk of lethal aneuploidies.
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Affiliation(s)
- S Gabrielli
- Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
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Gillham JC, Anand S, Bullen PJ. Antenatal detection of cleft lip with or without cleft palate: incidence of associated chromosomal and structural anomalies. Ultrasound Obstet Gynecol 2009; 34:410-415. [PMID: 19790102 DOI: 10.1002/uog.6447] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To ascertain how many fetuses with prenatally diagnosed cleft lip with or without cleft palate have associated congenital structural and/or chromosomal abnormalities and whether there is an association with the anatomical type of cleft lip or palate. METHODS This was a retrospective review of infants referred to the North-West England Regional Cleft Lip and Palate (CLAP) team between January 2000 and January 2006. Referrals made to the Regional Fetal Management Unit (FMU) in the same time period were investigated to identify the corresponding antenatal ultrasound findings and data on termination of pregnancy and intrauterine fetal death. RESULTS Over the 6-year period investigated, 570 infants were referred to the FMU and/or CLAP team. Among these, there were 24 terminations of pregnancy, two intrauterine fetal deaths and one early neonatal death identified. Data on 69 of the 543 patients that survived were incomplete. Of 188 cases with unilateral and 34 cases with bilateral cleft lip +/- palate there were no karyotypical abnormalities without other structural abnormalities. The incidence of associated structural abnormalities varied with the anatomical type of cleft: that of unilateral cleft lip +/- palate was 9.8% (19/194), that of bilateral cleft lip and palate was 25% (11/44) and that of midline cleft lip and palate was 100% (11/11). None of 252 cases with isolated cleft palate was identified antenatally; of these, 5.6% (n = 14) had either karyotypical or associated structural abnormalities and 21.0% (n = 53) had a genetic syndrome as an underlying diagnosis. CONCLUSIONS It is essential to tailor the antenatal counseling of patients to the specific scan diagnosis, considering both the anatomical type of cleft and the presence or absence of associated abnormalities. It is inappropriate to offer invasive testing to all patients. The use of three-dimensional ultrasound as an adjunct should be considered in these patients to improve the accuracy of prenatal diagnosis.
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Affiliation(s)
- J C Gillham
- Fetal Management Unit, St Marys Hospital, Manchester, UK.
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Ngai CW, Martin WL, Tonks A, Wyldes MP, Kilby MD. Are isolated facial cleft lip and palate associated with increased perinatal mortality? A cohort study from the West Midlands Region, 1995–1997. J Matern Fetal Neonatal Med 2009; 17:203-6. [PMID: 16147824 DOI: 10.1080/14767050500072854] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the association between cleft lip and/or palate and perinatal mortality. METHODS A retrospective review was performed of cases of cleft lip/palate born to West Midlands residents from 1995 to 1997. Perinatal mortality for identified cases was compared with all births from 1995 to 1997. RESULTS 347 cases of cleft lip and/or cleft palate were delivered from 1995 to 1997. Thirty-six pregnancies were terminated due to parental wishes--2 were registerable births. There were 310 spontaneous registerable births (stillbirths/livebirths) with cleft lip and/or palate and 1 further late fetal loss. In 220 (70.5%), the lesion was isolated. Of these, there were 7 perinatal deaths, 5 had post mortems and no additional anomalies were identified. In 92 (29.5%) cases other abnormalities were identified. The overall perinatal mortality rate (PNMR) in the West Midlands, was 10.0/1000 total births. The overall PNMR for babies with facial clefts was 89.7/1000 total births. The PNMR for those with associated anomalies was 228.3/1000 live/still births. The PNMR for isolated facial clefts was 31.8/1000 live/still births, significantly higher than the background population (OR 3.3, 95% CI: 1.5-7.0). CONCLUSION Consideration should be given to screening the fetus at 20-24 weeks for facial deformity. This has implications for detection both of fetal anomalies and of a population at risk for adverse outcome.
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Affiliation(s)
- Cora W Ngai
- Department of Fetal Medicine, Division of Reproduction & Child Health, Birmingham Women's Hospital, and University of Birmingham, UK
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Wehby GL, Castilla EE, Goco N, Rittler M, Cosentino V, Javois L, McCarthy AM, Bobashev G, Litavecz S, Mariona A, Dutra G, López-Camelo JS, Orioli IM, Murray JC. Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149]. BMC Pediatr 2006; 6:9. [PMID: 16563165 PMCID: PMC1552061 DOI: 10.1186/1471-2431-6-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 03/24/2006] [Indexed: 11/10/2022] Open
Abstract
Background The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally. Methods/Design We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions. Discussion Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan their studies more effectively and encourage the development of similar research efforts to target other birth defects or infant outcomes such as prematurity and low birth weight.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, USA
| | - Eduardo E Castilla
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
- ECLAMC, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Norman Goco
- RTI International, Research Triangle Park, USA
| | | | - Viviana Cosentino
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Lorette Javois
- Center for Developmental Biology and Perinatal Medicine, National Institute of Child Health and Human Development, Bethesda, USA
| | | | | | | | - Alejandra Mariona
- Latin American Collaborative Study of Congenital Malformations (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Graca Dutra
- ECLAMC, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jorge S López-Camelo
- ECLAMC, Instituto Multidisciplinario de Biologia Celular (IMBICE), La Plata, Argentina
| | - Iêda M Orioli
- ECLAMC, Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
OBJECTIVE To assess the overall and cause specific mortality of people from birth to 55 years with cleft lip and palate. DESIGN Long term follow up study. SETTING Danish register of deaths. PARTICIPANTS People born with cleft lip and palate between 1943 and 1987, followed to 1998. MAIN OUTCOME MEASURES Observed and expected numbers of deaths, summarised as overall and cause specific standardised mortality ratios. RESULTS 5331 people with cleft lip and palate were followed for 170 421 person years. The expected number of deaths was 259, but 402 occurred, corresponding to a standardised mortality ratio of 1.4 (95% confidence interval 1.3 to 1.6) for males and 1.8 (1.5 to 2.1) for females. The increased risk of mortality was nearly constant for the three intervals at follow up: first year of life, 1-17 years, and 18-55 years. The participants had an increased risk of all major causes of death. CONCLUSIONS People with cleft lip and palate have increased mortality up to age 55. Children born with cleft lip and palate and possibly other congenital malformations may benefit from specific preventive health measures into and throughout adulthood.
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Affiliation(s)
- Kaare Christensen
- Center for the Prevention of Congenital Malformations, Institute of Public Health, University of Southern Denmark, DK-5000 Odense, Denmark.
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Bergé SJ, Plath H, von Lindern JJ, Appel T, Niederhagen B, Van de Vondel PT, Hansmann M. Natural history of 70 fetuses with a prenatally diagnosed orofacial cleft. Fetal Diagn Ther 2002; 17:247-51. [PMID: 12065955 DOI: 10.1159/000063402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study is an analysis of neonatal outcome in 70 fetuses diagnosed over a 10-year period as having cleft lip with or without cleft palate (CL-P) by ultrasonographic examination. METHODS We describe the natural history of these 70 fetuses with orofacial clefts and select those who may be candidates for fetal surgery. The sonograms of 70 fetuses with orofacial clefts were evaluated for the nature of the CL-P and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of 70 patients (90%). RESULTS The frequency of additional anomalies and the mortality rate varied with the type of cleft. Also, the frequency and type of chromosomal abnormalities varied with the type of cleft. The overall mortality rate was 63% (n = 44). 3 of the surviving 26 fetuses had severe associated anomalies. In 13 of the remaining 23 cases, the fetal age at diagnosis (> or =22 weeks) excluded the fetuses from the potential benefits of fetal intervention. CONCLUSION Of 70 fetuses with prenatally diagnosed orofacial clefts, only 10 (14%) were candidates for fetal CL-P surgery.
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Affiliation(s)
- Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery, Division of Prenatal Diagnosis and Therapy, Friedrich Wilhelm University, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany.
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Abstract
UNLABELLED AIMS AND PATIENTS: Visualization of sonographic anatomy of the fetal face has acquired special importance, as conspicuous features in the phenotype facilitate the diagnosis of syndrome-like or chromosomally induced clinical conditions. Between 1990 and 1999, an orofacial cleft was diagnosed sonographically in 70 fetuses at the Clinic for Prenatal Diagnosis and Therapy of Bonn University Hospital. The aim of the study was to investigate whether the type of cleft correlates with the prevalence of associated anomalies or with karyotyping after amniocentesis. The types of associated anomalies and the neonatal outcome of these 70 fetuses were also reexamined. RESULTS We found a clearly positive correlation with the type of cleft, both for the associated anomalies and for the karyotype. The size of the cleft was much smaller with normal karyotypes than in the case of fetuses with trisomy 18. The trisomy 13 fetuses displayed the most pronounced clefts. None of the fetuses with an isolated lip cleft had an associated anomaly; all were born alive and could be treated surgically. In contrast, all the fetuses with a median cleft had severe associated anomalies that were incompatible with life. Associated anomalies occur more frequently with bilateral cleft lip and palate than with unilateral clefts. The fetuses with a unilateral cleft had a higher survival rate than those with a bilateral cleft. The most common associated anomaly in cleft fetuses is located in the region of the central nervous system. DISCUSSION Early sonographic information on cleft formation in combination with the karyotype can give rise to differentiated obstetric measures up to the point of termination of pregnancy in the event of an infaust prognosis.
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Affiliation(s)
- S J Bergé
- Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Rheinische Friedrich-Wilhelms-Universität, Welschnonnenstrasse 17, 53111 Bonn.
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Nembhard WN, Waller DK, Sever LE, Canfield MA. Patterns of first-year survival among infants with selected congenital anomalies in Texas, 1995-1997. Teratology 2001; 64:267-75. [PMID: 11745833 DOI: 10.1002/tera.1073] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few registry-based studies have investigated survival among infants with congenital anomalies. We conducted a registry-based study to examine patterns and probability of survival during the first year of life among infants with selected congenital anomalies. METHODS Data from the Texas Birth Defects Monitoring Division were merged with linked birth-infant death files for 2,774 infants born January 1, 1995 to December 31, 1997, with at least 1 of 23 common anomalies. Deaths before the first birthday were assessed from infant death files. Kaplan-Meier was used to estimate first-year survival; first-year survival was assessed for specific anomalies and by the number of life-threatening anomalies. RESULTS Overall, 80.8% of infants with these 23 anomalies survived the first year of life. We observed the highest survival rates for infants with gastroschisis (92.9%, 95% CI = 86.8, 96.3), trisomy 21 (92.3%, 95% CI = 89.5, 94.4) or cleft lip with or without cleft palate (87.6%, 95% CI = 84.0, 90.5). Infants with intermediate survival rates included those with microcephaly (79.7%; 95% CI = 73.6, 84.6), tetralogy of Fallot (75.0%; 95% CI = 65.5, 82.2), or with diaphragmatic hernia (72.8%; 95% CI = 61.8, 81.2). As expected, all infants with anencephaly and almost all infants with trisomy 13 or trisomy 18 died during the first year of life. First-year survival declined as the number of co-occurring life-threatening anomalies increased. CONCLUSIONS Overall, first-year survival for infants with congenital anomalies was high. Additional population-based studies are needed to quantify improvements in first-year survival.
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Affiliation(s)
- W N Nembhard
- University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas 77030, USA.
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13
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Abstract
Children born with a facial cleft are not thought to be at a greater risk for infant mortality than are those without congenital anomalies. The purpose of this study was to investigate whether the presence of a facial cleft alone or its coexistence with other anomalies increases a child's risk for dying. Birth and death certificate data from Washington State for the years 1984 to 1988 were linked for infants who died before 1 year of age. Mortality rates for different types of facial clefts and for births without noted abnormalities were compared. Relative to infants with no diagnosed abnormalities noted in the birth certificate, infants with facial clefts without other abnormalities have a 3.7 fold increased odds for dying during their first year of life. This elevated risk for dying was fairly consistent during the first year of life. When facial clefts are associated with other abnormalities there is an 82.3 fold increase in odds for mortality during the first year of life. This elevated risk is highest during the neonatal period; 77% of all deaths occurred during the first 27 days. It is concluded that infants with facial clefts with or without associated anomalies have a significantly increased mortality risk when compared to infants without any diagnosed abnormalities at birth.
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Affiliation(s)
- P P Hujoel
- Department of Dental Public Health, University of Washington, Seattle 98195
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14
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Oka T, Tohnai I. [Etiological factors in cleft lip and palate. Epidemiologic study]. Shikai Tenbo 1985; 66:319-26. [PMID: 3866325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Fetal mortality data from Lancaster, Penn., Chicago, Ill. and Minneapolis, Minn. are presented which support the authors' earlier findings in Indiana and Montreal that a positive relationship exists between the degree of liability to malformation and the incidence of fetal deaths in probands' sibships. Altogether, the study involved 189 CL sibships, 690 CLP sibships, and 3,416 pregnancies. On the basis of these data, which are derived from families of several different backgrounds of European ancestry, it is generalized that, as we proceed from CL sibships to CLP sibships, there is a doubling effect on fetal mortality. The consistency of this finding in several population samples is impressive. The implications of this observation are discussed with reference to genetic counseling.
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Abstract
A total of 613 cases of cleft lip, cleft palate, and combinations of both (CLP(P)) has been ascertained in the period from 1958 to 1975 in Western Australia. Near-total ascertainment of cases during this period was obtained from multiple sources. There has been a significant decline in the total incidence and the cleft lip and palate (CLP) incidence in males. The hypothesis is presented that these changes are linked to the changing fertility pattern throughout Australia (as technological improvements are made in the simplicity and efficacy of birth control), and abortion (as social attitudes change); and as the birthrate drops towards zero population growth (ZPG). The paper presents two critical observations: (i) the link between CLP(P) incidence, and demographic changes; (ii) in differing behaviour of cleft lip (CL) and CLP, which were previously regarded as linked conditions.
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Abyholm FE. Cleft lip and palate in Norway. I. Registration, incidence and early mortality of infants with CLP. Scand J Plast Reconstr Surg 1978; 12:29-34. [PMID: 566463 DOI: 10.3109/02844317809010477] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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18
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Klásková O. [Incidence of cleft lip and palate in Bohemia]. Rozhl Chir 1974; 53:147-50. [PMID: 4819998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Emanuel I, Culver BH, Erickson JD, Guthrie B, Schuldberg D. The further epidemiological differentiation of cleft lip and palate: a population study of clefts in King County, Washington, 1956-1965. Teratology 1973; 7:271-81. [PMID: 4807129 DOI: 10.1002/tera.1420070308] [Citation(s) in RCA: 46] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Mackeprang M, Hay S. Cleft lip and palate mortality study. Cleft Palate J 1972; 9:51-63. [PMID: 4500296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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21
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Bulatovskaia BI, Kuznetsova NS. [Causes of death in children with congenital clefts of the upper lip and palate]. Stomatologiia (Mosk) 1971; 50:47-50. [PMID: 5288317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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22
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Pape HD, Schettler D. [Studies on the causes of death following cleft lip and cleft palate surgery]. Dtsch Zahnarztl Z 1969; 24:272-9. [PMID: 5252379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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24
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Ferrara P. [Statistical studies of the mortality in Italy from cleft palate and lip]. Ann Stomatol (Roma) 1967; 16:1061-4. [PMID: 5242097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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