Division of Plastic and Reconstructive Surgery, University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, PA.
J Craniofac Surg. 2021 May 1;32(3):947-951. doi: 10.1097/SCS.0000000000007353.
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 = 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 palate-specific 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 = 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n = 322) from January 2015 through August 2019. 81.4% (n = 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 = 0.002) and CLP (P = 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.
在小儿普通外科文献中，已经表明先天性异常的产前诊断是父母心理困扰的独立预测因素。手术产前咨询可以通过帮助家庭了解婴儿的手术需求和潜在结果来降低父母的焦虑。在这项回顾性分析中（n=440），作者旨在展示我们对产前诊断的唇裂和腭裂（CL/P）的护理途径，并通过比较接受产前 CL/P 咨询的患者队列和仅在产后就诊的患者队列的临床和手术护理时间来探讨唇裂和腭裂特定的产前咨询对患者护理的影响。作者假设我们的多学科产前护理干预与产后就诊时间较早和手术修复有关。将所有母亲接受产前 CL/P 咨询的患者（产前组，n=118）的护理与我院所有没有产前咨询的新 CL/P 患者（产后组，n=322）进行比较，时间从 2015 年 1 月到 2019 年 8 月。产前组中 81.4%（n=96）的患者在产后返回接受治疗，而 2 例妊娠中断，4 例新生儿死亡，15 例患者未返回接受治疗。产前咨询与产后就诊预约时间较早相关（P<0.001），以及仅唇裂（P=0.002）和唇腭裂（P=0.047）患者的 CL 修复时间更短。我们描述的产前和产后 CL/P 途径是一个多学科模式，与从产前到完全手术修复的高保留率相关。
