Abstract
Objective: 1) To determine national trends in the rates of failure to thrive (FTT) and subsequent gastrostomy tube placement in infants with cleft palate. 2) To identify risk factors for developing FTT and/or gastrostomy tube placement in the setting of underlying dysphagia related to cleft palate.
Method: Retrospective series. The Kids’ Inpatient Database 2006 was analyzed for children under 1 year of age with any form of cleft palate with and without the diagnosis of FTT. The cohort of children with cleft palate and FTT were analyzed for procedure codes indicating gastrostomy placement during admission.
Results: In total, 12,067 children under 1 year of age with cleft palate were identified. Of these, 2,085 (17%) also had the diagnosis of FTT. Children with cleft palate and FTT had a g-tube placement rate of 18%, with the overall rate of g-tube placement for any infant with cleft palate being 3%. Odds of FTT among infants with cleft palate were significantly elevated for those with reflux, musculoskeletal anomalies, atrial or ventricular septal defect, circulatory system anomalies, and respiratory problems. Similar concurrent diagnoses increased the odds ratios for g-tube placement in infants with cleft palate and FTT.
Conclusion: Failure to thrive among infants with cleft palate approaches 20%. Children with gastrointestinal, cardiac, and respiratory comorbidies are particularly at risk and gastrostomy tube placement for feeding supplementation may be required. Infants without these comorbidities may benefit from longer trials of conservative feeding interventions prior to surgical intervention.
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