The Impact of Congenital Cardiovascular Malformations on the Assessment and Surgical Management of Infants with Cleft Lip and/or Palate

Harry, Brian L.; Tebockhorst, Seth; Deleyiannis, Frederic W.‐B.

doi:10.1597/12-131

Cited by 19 publications

(51 citation statements)

References 29 publications

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“…23 Anemia in CL/P patients is attributed mainly to feeding difficulty, while respiratory problems are frequently associated with irritation of the nasal and respiratory cavities by food and saliva, which also predisposes to recurrent infections. The frequency of cardiovascular malformations found by Harry et al 24 in 10% of CL/Ps cases was similar to that of the present study. Cardiac anomalies are associated with the common development of both palate and heart between 5 and 9 weeks of gestation as part of cardiac and craniofacial development, which relies on complex signaling processes among interdependent embryonic tissues.…”

Section: Discussionsupporting

confidence: 93%

“…Cardiac anomalies are associated with the common development of both palate and heart between 5 and 9 weeks of gestation as part of cardiac and craniofacial development, which relies on complex signaling processes among interdependent embryonic tissues. 24 Other complications commonly seen in CL/P patients are related to neuropsychomotor development. We observed concomitant motor, speech, and behavioral delay, followed by speech delay only.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors and comorbidities in Brazilian patients with orofacial clefts

et al. 2018

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Considering that environmental risk factors substantially contribute to the etiology of orofacial clefts and that knowledge about the characteristics and comorbidities associated with oral clefts is fundamental to promoting better quality of life, this study aimed to describe the risk factors, main characteristics, and comorbidities of a group of patients with cleft lip and/or cleft palate (CL/P) from Rio Grande do Norte (RN), Brazil. Data were obtained from 173 patients with CL/P using a form from the Brazilian database on Orofacial Clefts. Most patients were male with cleft lip and palate and had a normal size and weight at birth; presented few neonatal intercurrent events; and had anemia and respiratory and cardiovascular diseases as main associated comorbidities. They also required timely surgical rehabilitation and multidisciplinary care to stimulate their neuropsychomotor development. In addition, a high frequency of familial recurrence and of parental consanguinity was evidenced in the studied population, especially for the cleft lip and cleft palate type. Other relevant findings were the considerable maternal exposure to alcohol, infections, smoking, and hypertension, as well as low supplementation with vitamins and minerals and deliberate consumption of analgesics, antibiotics, and antihypertensives during pregnancy. Characterization of the CL/P patient profile is essential for the planning of health services and integration among the health professionals involved in the diagnosis and treatment of these malformations. Our results reinforce the need for additional research to confirm the association between environmental factors and the development of orofacial clefts.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Risk factors and comorbidities in Brazilian patients with orofacial clefts

et al. 2018

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“…There is a high incidence of associated congenital heart disease in children undergoing cleft lip and palate surgery. [ 18 19 ] The hemodynamic responses to adrenaline infiltration can be potentially hazardous in these children as it can alter the shunt fraction. The results of this study may guide the choice of anesthetic agents during adrenaline infiltration.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic response to adrenaline infiltration in children undergoing cleft palate repair during general anesthesia with sevoflurane and isoflurane

Gunnam

Durga

Gurajala

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Systemic absorption of adrenaline often used for infiltration during cleft palate surgery leads to adverse hemodynamic responses. These hemodynamic responses may be attenuated by the volatile anesthetics. This study aims to compare the hemodynamic responses to adrenaline infiltration during isoflurane (ISO) and sevoflurane (SEVO) anesthesia.Material and Methods:Sixty children aged between 9 months and 48 months, weighing between 8 kg and 20 kg, undergoing primary repair of cleft palate were randomly allocated into two groups: Group ISO - anesthesia maintained with ISO (2 minimum alveolar concentrations [MAC]) and nitrous oxide 50% and group SEVO - maintained on SEVO (2 MAC) and nitrous oxide 50%. Surgical site was infiltrated with 1 ml/kg of 1:200,000 solution of adrenaline with 0.5% lignocaine. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were noted at the end of infiltration and every 1 min for 5 min following infiltration. The percentage change of hemodynamic responses from baseline, following infiltration were compared between the two groups.Results:There was no significant change in HR from baseline, and the response was comparable between the agents at all times. The blood pressure (BP) increased from baseline in both the groups but the increase was greater in SEVO than ISO group at 2 and 3 min after infiltration. The maximum change in HR from baseline (group ISO median 10.9% [interquartile range (IQR) 4.5-23.0] vs. group SEVO 26.5% [11.9-44.6]) was comparable in both the groups (P = 0.169). The maximum change in SBP was significantly greater in group SEVO than group ISO (42.8% [IQR 20.0-60.9] vs. 26.0 [11.3-44.5], P = 0.04). The incidence of significant change (>20%) of SBP, DBP, and MAP from baseline was significantly greater in group SEVO after infiltration and 1 min and 2 min after infiltration. There were no arrhythmias in any of the groups.Conclusion:Isoflurane results in greater attenuation of rise in BP during adrenaline infiltration compared to SEVO at similar MAC.

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“…Greater awareness of the guidelines for SBE prophylaxis is needed. Most cleft patients with a cardiovascular malformation do not require cardiac surgery and do not experience an increased rate of complications associated with cleft surgery [15]. During pre and postoperative care nurses who work continuously and closely with the patients should have knowledge, experience and ability to take excellent care of their patients and families.…”

Section: Background Of the Studymentioning

confidence: 99%

Effectiveness of Structured Teaching Program (STP) on Knowledge and Practice of Post-Operative Care among Parents of Children with Cleft Lip and Cleft Palate

Ekata¹,

Sorte²,

Chanu³

2017

Pediatr Ther

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It is a study to assess the effectiveness of structured teaching programme on knowledge and practice of postoperative care among parents of children with cleft lip and cleft palate in a selected hospital, Dehradun, Uttarakhand. Objective:The main objectives of the study was to compare the post-test knowledge of parents on postoperative care of cleft lip and cleft palate in control and experimental group and to assess the post-test practice of parents on post-operative care of cleft lip and cleft palate in control and experimental group.Methodology: Quasi-experimental, two groups pre-test and post-test designs were used in the study. The study was done in selected hospital Dehradun, Uttarakhand. The sample comprised of 60 parents of children with cleft lip and cleft palate who fulfilled inclusion criteria. All the participants who are available at the time of data collection were taken consecutively. Data was collected from participants by conducting interview schedule using structured knowledge questionnaire and observation practice checklist. Result:The result showed that in experimental group the mean post-test knowledge score (18.90 ± 0.95) was higher than the mean post-test knowledge score (10.46 ± 1.52) in control group which was found statistically significant at p<0.05. The mean post-test practice score in experimental group in day 1 was 10.40 ± 1.95 which was higher than the control group 7.00 ± 1.59 and the 't' value was 7.36. Again the mean post-test practice score in experimental group in day 2 was 11.80 ± 1.95 which was higher than the control group 6.66 ± 1.72 and the 't' value was 11.84. On third day the mean post-test practice score in experimental group was 10.76 ± 2.26 which was higher than the control group 6.43 ± 1.45 and the 't' value was 8.80. Hence the score predict that there was significant difference between the mean post-test practice in experimental and control group at p<0.05 level. So there was no evidence to accept the null hypothesis, hence the researcher rejects the null hypothesis and accepted the research hypothesis. Conclusion:It was concluded that structured teaching programme on post-operative care of cleft lip and cleft palate was effective in increasing knowledge and practice of parents.

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The Impact of Congenital Cardiovascular Malformations on the Assessment and Surgical Management of Infants with Cleft Lip and/or Palate

Cited by 19 publications

References 29 publications

Risk factors and comorbidities in Brazilian patients with orofacial clefts

Risk factors and comorbidities in Brazilian patients with orofacial clefts

Comparison of hemodynamic response to adrenaline infiltration in children undergoing cleft palate repair during general anesthesia with sevoflurane and isoflurane

Effectiveness of Structured Teaching Program (STP) on Knowledge and Practice of Post-Operative Care among Parents of Children with Cleft Lip and Cleft Palate

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