Preoperative nutrition intervention program increases cleft surgery eligibility in the low- and middle-income country setting.

Abstract

Background: Children with cleft lip and/or palate (CL/P) are highly susceptible to malnutrition, which may restrict surgery eligibility and delay repair. Preoperative nutrition programs for children with unrepaired CL/P are an effective treatment to overcome malnutrition for safe surgical intervention in high-resource settings; however, the effectiveness of such programs has not been demonstrated in the setting of low- and middle-income countries (LMICs). We studied the impact of a preoperative nutrition program on improving nutritional status and achieving surgical eligibility for children with CL/P.

Methods: A retrospective review of patients treated by the Operation Smile (OS) Durgapur Cleft Centre in India from March 2021 to December 2022 was conducted. Patient gender, weight, age, cleft type, parental demographics, and income were recorded. The patients' malnutrition status was categorized as "mild", "moderate", or "severe" based on the Indian Academy of Pediatrics (IAP). Patient IAP classifications were noted at multiple timepoints, where change in nutrition status overtime served as the primary outcome of this study. Whether the child became eligible for surgery was assessed as a secondary outcome. Descriptive statistics used t-tests for continuous variables and chi-squared tests for categorical variables. P-values < 0.05 were considered significant.

Results: The study included 236 patients who presented for nutritional intervention after being deemed ineligible for surgery. Initial IAP malnutrition classifications were 36.9% (n = 87) mild, 42.8% (n = 101) moderate, and 20.3% (n = 48) severe malnutrition. After intervention, 179 (75.8%) patients improved in IAP nutrition status, 49 (20.7%) maintained baseline status, and only eight (3.4%) declined. Final improvement levels were significantly associated with younger age at intake (p < 0.001) and maternal education background (p = 0.011). At study end, a total of 183 (77.5%) patients were eligible for cleft repair while 53 (22.5%) patients were malnourished and remained enrolled in the program. A total of 162 (68.6%) patients underwent surgery.

Conclusion: Malnutrition prevents children with CL/P from receiving surgical care in LMICs. This nutrition intervention enabled 228 (96.6%) patients to improve or maintain baseline nutrition and 183 (77.5%) to become surgically eligible who would not have been eligible otherwise. Preoperative nutrition programs offer a promising solution to addressing malnutrition as a barrier to timely, safe cleft repair in resource-constrained settings.