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Enteral Feeding Access in Patients with Orofacial Clefts
Nicholas S. Adams, MD1, Thanapoom Boonipat, BS2, Robert J. Mann, MD3, John W. Polley, MD3, John A. Girotto, MD3.
1Michigan State University, Grand Rapids, MI, USA, 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 3Helen DeVos Children's Hospital, Grand Rapids, MI, USA.

Purpose: Failure to thrive is seen in up to 49% of patients with orofacial clefts. Enteral feeding access (EFA) is often necessary to supplement or replace nutrition. EFA is associated with significant complications and morbidity. This study evaluates the incidence and risk factors associated with EFA in patients with orofacial clefts.
Methods: The HCUP KID database from 2000 to 2012 was analyzed for patients with orofacial clefts, comorbidities, and EFA using ICD-9-CM diagnosis and procedure codes. Chromosome abnormalities and congenital heart defects were analyzed as comorbidities.
Results: A total of 46,617 patients with orofacial clefts were identified, 14.6% with isolated cleft lip (CL), 51.7% with cleft lip and palate (CLP), and 33.7% with isolated cleft palate (CP). The incidence of patients requiring EFA increased from 2000 (3.7%) to 2012 (5.8%) (p<0.001). After controlling for comorbidities, the incidence was again found to increase throughout the study period (3.3% to 5.0%, p<0.001). Patients with comorbidities were noted to have higher rates of EFA that increase significantly between 2000 and 2012 (12.8% to 18.6%, p=0.019). Treatment in an urban teaching hospital was an independent risk factor for EFA (OR 4.65). Race and income were not independent risk factors.
Conclusion: The rates of EFA in patients with orofacial clefts increased substantially between 2000 and 2012, even after controlling for comorbidities. Patients with CP comprised the majority, which is consistent with a higher incidence of comorbidities in this population. The use of EFA is associated with a multitude of complications. Unnecessary use should be minimized.


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