Diagnosis and Detection

Delayed detection of cleft palate: an audit of newborn examination

[Abstract] ((Habel, look A., story Elhadi, N., Sommerlad, B., and Powell, J. Delayed detection of cleft palate: an audit of newborn examination. Archives of Disease in Childhood 2006;91:238-240. Available online at: http://adc.bmj.com/ – requires registration (free) ))

Aims: To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination.

Methods: Audit of hospital notes, parental questionnaire incorporating open ended questions, and telephone questionnaire of junior doctors in the referring hospitals incorporating fixed choice questions. All open cleft palate patients without cleft lip referred from 1988 to 2001 to a tertiary centre, Great Ormond Street Hospital for Children (London), and a district general hospital Plastic Surgery Centre, St Andrew, Billericay were audited.

Results: Of 344 cleft palate patients without cleft lip or submucous cleft palate, the day the cleft was detected was recorded in 92%. Delayed detection, after the first day, was 28% overall, distributed as 37% with isolated cleft palate and 23% with syndromic cleft palate. Narrow V shaped clefts were more likely to be delayed in detection compared with broad U shaped clefts, as were soft palate clefts compared with hard palate clefts. Five with isolated cleft palates were not detected until after the first year. Babies born at home were unlikely to be detected on day 1. Symptoms were significantly increased in the delayed detection group for feeding problems and nasal regurgitation. A telephone questionnaire of trainee paediatricians in referring units revealed that digital examination was more commonly practised than visual inspection, and few recalled receiving specific instruction on examination of the palate.

Conclusion: Delayed detection of cleft palate was not uncommon, and the features of those more likely to be missed suggested digital examination was related. Trainee doctors and midwives should be instructed to inspect visually using a light and tongue depressor, then digitally if submucous cleft palate is suspected.

Delayed detection of cleft palate after the first day of life occurred in 28% of referrals. Detection was more common in isolated cleft palate (37%) than syndromic cleft palate (23%), and narrow V shaped than broad U shaped clefts.

The appropriate technique is visual inspection of all newborn palates, followed by digital examination where submucous cleft palate is suspected.

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