Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany.
Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
Arch Dis Child Fetal Neonatal Ed. 2021 Jan;106(1):104-109. doi: 10.1136/archdischild-2019-317890. Epub 2020 May 14.
Infants with craniofacial malformations (CFMs) are at increased risk of various clinical problems, including respiratory and feeding disorders, the result of which may be long-lasting. An improvement in clinical care can be achieved by prenatal diagnosis and interdisciplinary birth preparation. Feeding problems may particularly be stressful for the family and require a team approach involving nursing staff, speech therapists and nutritional specialists to anticipate, avoid and treat sequelae such as failure to thrive or recurrent aspirations. Special techniques (eg, optimisation of breast feeding, alternative feeding methods or manual orofacial therapy) may be used individually to improve feeding competence; supplemental nutrition via a nasogastric or gastrostomy tube may be temporarily necessary to ensure adequate weight gain. The high prevalence of respiratory disorders in infants with craniofacial abnormalities requires anticipation and screening to prevent growth failure and neurological deficits. Treatment of upper airway obstruction varies widely, strategies can be divided into non-surgical and surgical, and in those aimed at widening the pharyngeal space (eg, prone position, palatal plates, craniofacial surgery) and those bridging the narrow upper airway (eg, nasopharyngeal airway, modified palatal plate, pneumatic airway stenting, tracheostomy). The complex management of an infant with CFM should be performed by a multidisciplinary team to offer specialised support and care for affected families.
颅面畸形（CFM）患儿存在多种临床问题的风险增加，包括呼吸和喂养障碍，其结果可能是长期的。通过产前诊断和跨学科的分娩准备，可以改善临床护理。喂养问题可能会给家庭带来特别大的压力，需要一个团队方法，包括护理人员、言语治疗师和营养专家，以预测、避免和治疗生长不良或反复吸入等后遗症。特殊技术（例如，优化母乳喂养、替代喂养方法或手动口腔治疗）可单独用于提高喂养能力；通过鼻胃管或胃造口管进行补充营养可能暂时需要以确保足够的体重增加。颅面畸形患儿呼吸障碍的高发率需要进行预测和筛查，以预防生长不良和神经缺陷。上气道梗阻的治疗方法多种多样，策略可分为非手术和手术，包括扩大咽腔（例如，俯卧位、腭板、颅面手术）和桥接狭窄的上气道（例如，鼻咽气道、改良腭板、气动气道支架、气管切开术）。患有 CFM 的婴儿的复杂管理应由多学科团队进行，为受影响的家庭提供专门的支持和护理。
