Factors Associated With Adherence to Nasoalveolar Molding (NAM) by Caregivers of Infants Born With Cleft Lip and Palate

Objective: Identify factors associated with adherence to nasoalveolar molding (NAM) therapy. Design: Retrospective case-control study. Setting: Tertiary referral center. Patients, Participants: Infants with cleft lip, with or without cleft palate, referred for NAM. One hundred thirty-five patients met criteria. Main Outcome Measure(s): Adherence to NAM therapy, defined as continuous use of the appliance and attendance of NAM adjustment visits. Results: Female sex (OR = 2.85, 95% CI 1.21-6.74), bilateral cleft (OR = 2.88, 95% CI 1.29-6.46), and travel distance (OR = 1.01, 95% CI 1.00-1.01) were independent predictors of nonadherence. Bilateral clefts (OR = 8.35, 95% CI 2.72-25.64) and public-payer insurance (OR = 3.67, 95% CI 1.13-11.91) for male patients were significantly associated with nonadherence, in our sex-stratified multivariate model. The majority of the families (58%) had public health insurance. Males comprised 77.0% of the cohort. Conclusions: NAM treatment adherence is impaired by bilateral clefts, female sex, increased travel distance, and public insurance. Further studies are warranted to investigate how these factors affect adherence, and to develop interventions to improve adherence in families at risk due to economic or psychosocial barriers.