Somatic growth of non-syndromic cleft lip and/or palate subjects compared with the general population in a developing country

A number of studies of somatic growth in non-syndromic cleft lip and palate (CL/P) subjects in developed countries have found small differences from the general population. In contrast there is a dearth of such growth studies in developing countries which enable comparison with the local population. The aim of this thesis is to record the growth in CL/P subjects having primary surgery in Sri Lanka and analyse differences in growth from the non-cleft population. Much of the developing world is affected by undernutrition and the question arises whether growth is further compromised in CL/P subjects. In the context of the Sri Lanka Cleft Lip and Palate Project, one of whose aims has been to provide primary lip and palate surgery for affected individuals of all ages, a subsidiary question ensues: does the age at surgery affect growth outcomes? To evaluate these postulates in 364 CL/P subjects aged 3 months to 64 years, measurements of height, weight, head circumference, arm circumference, skin fold thickness and Tanner pubertal stage were performed. In addition hand x-rays were selectively obtained. Data was collected on one to five occasions in five visits to Sri Lanka over 19 years. A comparison was made with a non-cleft population in a cross-sectional study of 3,265 individuals aged from three months to 24 years, done in collaboration with the Paediatric Department of the University of Ruhuna, Sri Lanka. Growth, the tempo of growth and pubertal change, and skeletal maturation were delayed and final stature reduced in both CL/P and non-cleft subjects compared to subjects in the developed world. Applying the British 1990 Growth Reference CL/P subjects were more adversely affected than the non-cleft population in stunting (height ≤2SD) underweight (weight ≤2 SD) and thinness in frequency and severity throughout most of the growth period. Catch-up growth in subjects with CL/P occurred in puberty, to that of the non-cleft population. Primary palate surgery performed in childhood had lower prevalence of undernutrition indices than if adolescent or adult at the time of surgery. The growth of cleft lip, in whom early nutrition is not compromised, was similar to those with cleft palates, in whom pre-surgical nutrition could have been impaired. This suggests other factors in addition to nutrition may be influential, such as parental emotional responsiveness and societal inclusion. These findings may inform future local educational and management strategies to improve growth outcomes

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5, 303 hlm.;ilus.;19 c

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