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Rethinking The Rule Of 10s: Early Cleft Lip Repair Improves Weight Gain
Katelyn Kondra, MD1,2, Eloise Stanton, BA1,2, Christian Jimenez, BS1, Kalvyn Ngo, BS3, Jordan Wlodarczyk, MD2, Laya Jacob, BS1,2, Naikhoba Munabi, MD1, Kevin Chen, MD2, Mark Urata, MD, DDS2,1, Jeffrey Hammoudeh, MD, DDS2,1.
1Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA, 2Children's Hospital Los Angeles, Los Angeles, CA, USA, 3Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.

PURPOSE: This study compares patients undergoing early cleft lip repair (ECLR) and traditional lip repair (TLR) with or without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms.
METHODS: A retrospective chart review evaluated patients who underwent ECLR or TLR±NAM from November 2009 through January 2020. Patient demographics, birth and medical history, perioperative variables and complications were collected. Infant weights, using age-based percentiles, were recorded at the time of operation, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcome measure was weight percentile amongst ECLR and TLR±NAM groups.
RESULTS: 107 patients met inclusion criteria: ECLR, n=51 (47.6%); TLR+NAM, n=35 (32.7%); and TLR-NAM, n=21 (19.6%). There were no major adverse events recorded with the ECLR operations. A novel dexmedetomidine-based neonatal anesthetic protocol (DBNAP), with perioperative equivalence to traditional volatile agents, was developed for patients undergoing ECLR; there were no major complications reported with the regimen. Age-matched weights in the ECLR group were significantly greater than the TLR+NAM group at time of surgery and 24-months postoperatively and greater than the TLR-NAM groups at time of surgery, 6-, 12-, and 24- months postoperatively (p<0.05). Significant associations between variables were calculated with independent Student’s t-tests. Descriptive statistics and significance testing were performed on SPSS Advanced Statistics version 17.0 (SPSS Inc, Chicago, Illinois).
CONCLUSION: The results of this study suggest that performing cleft lip repair on patients as young as 13 days old is safe and improves weight gain during infancy. No patients in this study suffered major complications, so a weight-based threshold to guide ECLR eligibility was unable to be established. ECLR significantly increased patient weights 24-months postoperatively when compared to TLR±NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.


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