Neonatal repair of cleft lip: a decision-making protocol

Purpose: Treatment of clefts lip during the neonatal period remains a controversial subject. Those who are in favor of delayed closure argue a higher-risk general anesthesia when it was performed in neonatal period. The purpose of this study was to evaluate the complications and the feasibility of this surgery during the neonatal period. Methods: This was a retrospective study of 61 children with labial, labioalveolar, labio-alveolo-palatine, and labiopalatine clefts between May 2000 and November 2006. Each patient's medical file and particularly his or her anesthesia file was used to record the principal demographic data, the results of the malformation workup, and preoperative complications. Results: Sixty-one newborns, 20 girls and 41 boys, aged 7.5 +/- 6.7 days were operated on. The mean weight on the day of surgery was 3190 454 g. Fifty-four children had a malformation workup (abdominal ultrasonography, spinal bone workup, transfontanelle ultrasonography, and cardiac ultrasonography). Thirteen associated malformations (21%) were thereby detected. There were no surgical complications. The anesthesiologists did not have any real intubation problems. In 4 cases, however, intubation was only possible after several laryngoscopies and changing the type of intubation shaft. There were no major complications. However, one child did present a preoperative complication. It was an episode of desaturation with bradycardia that was quickly resolved without further consequences in a child with a ventricular septal defect and an auricular septal defect. Conclusions: We think that neonatal lip closure should continue to be performed. It is essential for the psychological status of the parents. We have not found any studies in the literature that reported an anesthesia risk that was greater in the neonatal period than at 3 months in patients without risk of complications. (c) 2008 Elsevier Inc. All rights reserved.