What is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care

Abstract

In the pediatric general surgery literature, it has been shown that prenatal diagnosis of a congenital anomaly is an independent predictor of parental psychological distress. Surgical prenatal counseling can decrease parental anxiety by helping families understand the surgical needs and potential outcomes of their infant. In this retrospective analysis (n ¼ 440), the authors sought to present our care pathway for prenatally diagnosed cleft lip and palate (CL/P) and explore the impact of cleft lip and palatespecific prenatal counseling on patient care by comparing the timing of clinical and surgical care between a cohort of patients who received prenatal CL/P consultation and a cohort of patients only seen postnatally. The authors hypothesize that our multidisciplinary prenatal care intervention is associated with earlier postnatal clinic visits and surgical repair. The care of all patients whose mother's presented for prenatal CL/P consultation (prenatal cohort, n ¼ 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n ¼ 322) from January 2015 through August 2019. 81.4% (n ¼ 96) of the prenatal cohort returned for care postnatally while 2 pregnancies were interrupted, four neonates died, and 15 patients did not return for care. Prenatal consultation was associated with earlier postnatal clinic appointments (P < 0.001) as well as a shorter time to CL repair in patients with CL only (P ¼ 0.002) and CLP (P ¼ 0.047). Our described pre-and postnatal CL/P pathway is a multidisciplinary model associated with high retention rates from the prenatal period through complete surgical repair.

The Burden of Care of Nasoalveolar Molding: An Institutional Experience

“…This increased caretaking burden is reportedly associated with higher levels of depression and anxiety, although parents who are married or partnered might be more experienced at sharing workload within the home environment and in supporting each other in difficult circumstances 33 . When prenatal diagnosis is possible, prenatal counseling has been found to decrease parental anxiety and facilitate earlier postnatal intervention 34 . Protocols have been discussed to aid in multidisciplinary prenatal consultations and provide support to families 35 …”

“…33 When prenatal diagnosis is possible, prenatal counseling has been found to decrease parental anxiety and facilitate earlier postnatal intervention. 34 Protocols have been discussed to aid in multidisciplinary prenatal consultations and provide support to families. 35 Despite the greater burden associated with NAM therapy, caregivers of children with cleft deformities have been shown to experience better psychosocial outcomes than those without NAM therapy.…”

Socioeconomic Disparities in Failure to Thrive and Weight Gain for Patients With Cleft Lip and Palate

“…1 Untreated orofacial clefting leads to a diverse set of sequelae including aesthetic 2 and functional deficits such as hindered feeding, 3 delayed speech and language development, 4 hearing dysfunction, 5 and psychosocial distress. 6 Optimal treatment of CL/P begins early with prenatal evaluation 7 and continues longitudinally throughout childhood and adolescence, often necessitating high levels of patient engagement and follow-up with multidisciplinary services to optimize outcomes. 8,9 While treatment of CL/P has economic benefits to societies and aversion of disability-adjusted life years, 10 comprehensive cleft care often necessitates a high degree of financial resources and planning by patients and families, 11 although total costs and value-based care have been challenging to quantify.…”

Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations

“…5,6 The American Cleft Palate-Craniofacial Association (ACPA) established criteria to optionally achieve "ACPA Team Approval" status, outlining parameters regarding team composition, team management, communication, cultural competence, psychological/social services, and outcomes assessment. 7 While these criteria certainly chaperone families and caregivers in selecting an optimal cleft and craniofacial team, approval status does not reflect the quality or clinical outcomes, and recent literature has suggested additional factors such as center volume, 8 center geography, 9 prenatal services, 10 surgical planning, 11 and social services 12 may impact cleft and craniofacial patient outcomes and caretaker experience, and thus are salient considerations for identifying the optimal team. Importantly, it should be acknowledged early in our discussion that for a substantial proportion of families, access and location barriers preclude the option of choosing between teams.…”