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Treatment of infants with craniofacial malformations
  1. Cornelia Wiechers1,2,
  2. Tabea Thjen2,3,
  3. Bernd Koos4,
  4. Siegmar Reinert2,5,
  5. Christian F Poets2,6
  1. 1Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
  2. 2Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
  3. 3Physical Therapy Centre, Tuebingen University Hospital, Tuebingen, Germany
  4. 4Department of Orthodontics, University of Tübingen, Tübingen, Baden-Württemberg, Germany
  5. 5Department of Craniofacial Surgery, Tuebingen University Hospital, Tuebingen, Germany
  6. 6Department of Neonatology, University of Tuebingen, Tuebingen, Germany
  1. Correspondence to Professor Christian F Poets, Dept. of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; christian-f.poets{at}med.uni-tuebingen.de

Abstract

Infants with craniofacial malformations (CFMs) are at increased risk of various clinical problems, including respiratory and feeding disorders, the result of which may be long-lasting. An improvement in clinical care can be achieved by prenatal diagnosis and interdisciplinary birth preparation. Feeding problems may particularly be stressful for the family and require a team approach involving nursing staff, speech therapists and nutritional specialists to anticipate, avoid and treat sequelae such as failure to thrive or recurrent aspirations. Special techniques (eg, optimisation of breast feeding, alternative feeding methods or manual orofacial therapy) may be used individually to improve feeding competence; supplemental nutrition via a nasogastric or gastrostomy tube may be temporarily necessary to ensure adequate weight gain. The high prevalence of respiratory disorders in infants with craniofacial abnormalities requires anticipation and screening to prevent growth failure and neurological deficits. Treatment of upper airway obstruction varies widely, strategies can be divided into non-surgical and surgical, and in those aimed at widening the pharyngeal space (eg, prone position, palatal plates, craniofacial surgery) and those bridging the narrow upper airway (eg, nasopharyngeal airway, modified palatal plate, pneumatic airway stenting, tracheostomy). The complex management of an infant with CFM should be performed by a multidisciplinary team to offer specialised support and care for affected families.

  • neonatology
  • physical therapy modalities
  • patient care team
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Footnotes

  • Contributors CW wrote the first draft of this manuscript, TT, BK and SR revised the manuscript for important intellectual input. CFP initiated this work and revised the manuscript for important intellectual input.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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