Department of Internal Medicine, Medical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
JAMA Netw Open. 2024 Sep 3;7(9):e2428077. doi: 10.1001/jamanetworkopen.2024.28077.
Cleft lip or palate is a prevalent birth defect, occurring in approximately 1 to 2 per 1000 newborns and often necessitating numerous hospitalizations. Specific rates of hospitalization and complication are underexplored.
To assess the rates of airway infection-associated hospitalization, overall hospital admissions, in-hospital complications, and mortality among children with a cleft lip or palate.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based cohort study used in-hospital claims data from the Federal Statistical Office in Switzerland between 2012 and 2021. Participants included newborns with complete birth records born in a Swiss hospital. Data were analyzed from March to November 2023.
Prevalent diagnosis of a cleft lip or palate at birth.
Outcomes of interest were monthly hospitalization rates for airway infections and any cause during the first 2 years of life in newborns with cleft lip or palate. In-hospital outcomes and mortality outcomes were also assessed, stratified by age and modality of surgical intervention.
Of 857 806 newborns included, 1197 (0.1%) had a cleft lip and/or palate, including 170 (14.2%) with a cleft lip only, 493 (41.2%) with a cleft palate only, and 534 (44.6%) with cleft lip and palate. Newborns with cleft lip or palate were more likely to be male (55.8% vs 51.4%), with lower birth weight (mean [SD] weight, 3135.6 [650.8] g vs 3284.7 [560.7] g) and height (mean [SD] height, 48.6 [3.8] cm vs 49.3 [3.2] cm). During the 2-year follow-up, children with a cleft lip or palate showed higher incidence rate ratios (IRRs) for hospitalizations due to airway infections (IRR, 2.33 [95% CI, 1.98-2.73]) and for any reason (IRR, 3.72 [95% CI, 3.49-3.97]) compared with controls. Additionally, children with cleft lip or palate had a substantial increase in odds of mortality (odds ratio [OR], 17.97 [95% CI, 11.84-27.29]) and various complications, including the need for intubation (OR, 2.37 [95% CI, 1.95-2.87]), extracorporeal membrane oxygenation (OR, 2.89 [95% CI, 1.81-4.63]), cardiopulmonary resuscitation (OR, 3.25 [95% CI, 2.21-4.78]), and respiratory support (OR, 1.94 [95% CI, 1.64-2.29]).
In this nationwide cohort study, the presence of cleft lip or palate was associated with increased hospitalization rates for respiratory infections and other causes, as well as poorer in-hospital outcomes and greater resource use.
唇裂或腭裂是一种常见的出生缺陷，在每 1000 名新生儿中约有 1 至 2 名发生，通常需要多次住院治疗。特定的住院率和并发症发生率尚未得到充分探讨。
评估唇裂或腭裂患儿的呼吸道感染相关住院率、总体住院率、院内并发症和死亡率。
设计、地点和参与者：本研究为全国范围内基于人群的队列研究，使用了瑞士联邦统计局 2012 年至 2021 年期间的住院索赔数据。参与者包括在瑞士医院出生的有完整出生记录的新生儿。数据分析于 2023 年 3 月至 11 月进行。
出生时存在唇裂或腭裂的明确诊断。
本研究的主要结局是在唇裂或腭裂新生儿生命的前 2 年内，每月因呼吸道感染和任何原因导致的住院率。还评估了院内结局和死亡率，按年龄和手术干预方式进行分层。
在纳入的 857806 名新生儿中，有 1197 名（0.1%）患有唇裂和/或腭裂，其中 170 名（14.2%）仅患有唇裂，493 名（41.2%）仅患有腭裂，534 名（44.6%）患有唇裂和腭裂。唇裂或腭裂患儿更可能为男性（55.8% vs 51.4%），出生体重较低（平均[标准差]体重，3135.6[650.8]g 与 3284.7[560.7]g），身高较矮（平均[标准差]身高，48.6[3.8]cm 与 49.3[3.2]cm）。在 2 年的随访期间，唇裂或腭裂患儿因呼吸道感染（发病率比 [IRR]，2.33[95%CI，1.98-2.73]）和任何原因（IRR，3.72[95%CI，3.49-3.97]）导致的住院率均高于对照组。此外，唇裂或腭裂患儿的死亡率（比值比 [OR]，17.97[95%CI，11.84-27.29]）和各种并发症的发生风险显著增加，包括需要插管（OR，2.37[95%CI，1.95-2.87]）、体外膜肺氧合（OR，2.89[95%CI，1.81-4.63]）、心肺复苏（OR，3.25[95%CI，2.21-4.78]）和呼吸支持（OR，1.94[95%CI，1.64-2.29]）的风险增加。
在本项全国性队列研究中，唇裂或腭裂的存在与呼吸道感染和其他原因导致的住院率增加、院内结局较差和资源使用增加相关。
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