Cleft Lip and Palate in Infants With Prenatal Opioid Exposure

Langa, Olivia C.; Cappitelli, Alex; Ganske, Ingrid M.

doi:10.1177/10556656211011896

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Five patients classified as LTFU were found to have followed up shortly after the study period ended, further emphasizing the shortcomings of LTFU as a measure of compliance in long-term care. Although this study's rate of LTFU (13%) was lower than or comparable to those demonstrated in the literature (range, 9%-33%), DTFU rates were substantially higher (50%) 11,18,19 . This suggests that DTFU may be an earlier or more sensitive measure of decreased compliance that could help identify at-risk patients before they experience definitive negative consequences, such as delay of key interventions or LTFU.…”

Section: Discussioncontrasting

confidence: 53%

“…Although this study's rate of LTFU (13%) was lower than or comparable to those demonstrated in the literature (range, 9%-33%), DTFU rates were substantially higher (50%). 11,18,19 This suggests that DTFU may be an earlier or more sensitive measure of decreased compliance that could help identify at-risk patients before they experience definitive negative consequences, such as delay of key interventions or LTFU. We also found that patients with at least 1 NS were significantly more likely to have DTFU.…”

Section: Discussionmentioning

confidence: 99%

“…First, LTFU lacks a consensus definition; various cutoffs have been used in the cleft literature alone 18,19 . Second, as a binary variable, it offers less information than continuous outcome measures.…”

mentioning

confidence: 99%

“…18 First, LTFU lacks a consensus definition; various cutoffs have been used in the cleft literature alone. 18,19 Second, as a binary variable, it offers less information than continuous outcome measures. Last and most importantly, it is a suboptimal measure of compliance in the context of long-term care.…”

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confidence: 99%

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Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

Byrnes

Miller

Frank³

et al. 2023

Ann Plast Surg

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Background Oral clefts require longitudinal multidisciplinary care with follow-up visits at regular intervals throughout a patient's childhood, and delayed care can be detrimental. Although loss to follow-up is commonly studied, this metric does not account for patients that do return to care, but months or years later than recommended. The aim of this study was to explore and determine risk factors for delay to follow-up (DTFU) in a cleft clinic at a rural academic center. Methods Medical records from the multidisciplinary cleft clinic at a single rural tertiary care institution between January 1, 2010, and December 31, 2019, were reviewed. The primary outcome was DTFU, measured as the difference in days between recommended and actual follow-up dates for a given visit. Results A cohort of 282 patients was analyzed, with a total of 953 visits. A total of 71% of patients experienced at least 1 delay in follow-up of 30 days or longer, and 50% had at least 1 delay of 90 days or longer. Out of all visits, the mean DTFU was 73 days (around 2.5 months). For 23% of patients, at least half their visits were delayed by more than 90 days, whereas 11% experienced a delay of more than 90 days with every visit. Patients who failed to show up to at least 1 appointment had significantly higher risk of DTFU (P < 0.0001). Driving distance, driving time, SES, stage of cleft care, and cleft phenotype were not correlated with DTFU. For canceled appointments, 50.5% of recorded cancellation reasons were patient driven. Conclusions Delay to follow-up in a multidisciplinary cleft clinic was prevalent in this rural cohort, with half of patients experiencing delays of 3 months or longer, and about 1 in 9 experiencing this delay with every visit. Delay to follow-up identifies patients with consistently high rates of delay in care, which could eventually lead to targeted interventions to increase compliance. Delay to follow-up may be a new and valuable measure of cleft care compliance that can be easily implemented by other institutions. Further investigation is needed to determine the relationship between delay and clinical outcomes in cleft patients.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

Byrnes

Miller

Frank³

et al. 2023

Ann Plast Surg

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When Cleft Lip and/or Palate and Antenatal Opioid Exposure Intersect: A Tutorial

Proctor-Williams

Louw

2022

Perspect ASHA SIGs

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Purpose: A new clinical subpopulation of cleft lip/palate (CL/P), which includes infants and children antenatally exposed to opioids, is increasingly appearing on CL/P teams and speech-language pathology caseloads. The purposes of this tutorial are to describe neonatal opioid withdrawal syndrome (NOWS), to offer a review of the NOWS feeding and neurodevelopmental outcomes literature, and to discuss the clinical and research implications for this new clinical population. Conclusions: Recent literature has pointed to a higher prevalence of CL/P in infants with NOWS, as compared to the live birth population. In addition to the typical feeding problems of infants with CL/P, other challenges emerge during the first several days of life for opioid-exposed infants in the neonatal intensive care unit (NICU). These feeding problems are characterized by disruption of the suck–swallow–breath process and are further complicated by the infant's state during withdrawal from opioids. There are trends across studies that suggest good reason for concern about adverse neurodevelopmental outcomes in opioid-exposed children. This includes evidence that children post-NOWS are at greater risk than children with typical development for speech; language and literacy impairments; and/or other cognitive, sensory, and behavioral problems. Children with CL/P already are at risk for speech, resonance, language, and feeding disorders. A history of antenatal opioid exposure may increase and add further complications. The SLP plays a key role in the management of and attitudes toward children with NOWS and CL/P in the NICU, on CLP teams, in early intervention, and in schools. This tutorial provides clinical guidelines for intervention with this new and growing population.

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One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study

et al. 2022

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Purpose: The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate. Method: This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development–Third Edition [Bayley-III] or Developmental Assessment of Young Children–Second Edition [DAYC-2]—due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample z tests. We report estimates, 95% confidence intervals, and two-sided p values. Results: We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains. Conclusions: Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population. Supplemental Material: https://doi.org/10.23641/asha.20044403

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Cleft Lip and Palate in Infants With Prenatal Opioid Exposure

Cited by 3 publications

References 29 publications

Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

When Cleft Lip and/or Palate and Antenatal Opioid Exposure Intersect: A Tutorial

One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study

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