SEARCHCOHORTpediatrics, nutrition

cohort·pediatrics, nutrition, surgery, public health, clinical nutrition·PMC10012294

The effect of short-term preoperative nutritional intervention for cleft surgery eligibility

BMC Nutrition · 14 authors, 9 centres

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TL;DR

This prospective cohort study of 556 children with orofacial clefts across six low- and middle-income countries found that short-term ready-to-use therapeutic food (RUTF) supplementation transitioned 63.7% of malnourished patients who returned for follow-up into nutritionally eligible surgical candidates, with a mean time to eligibility of 6 weeks.

Full summary

562 CHARS

At baseline, 28.2% had severe, 21.0% moderate, and 50.7% mild malnutrition. Mean z-score improved significantly from -2.5 to -1.7 by the second visit (p < 0.001), with a strong positive correlation between follow-up visits and z-score improvement (r = 0.87). Average time to attain surgical eligibility was 6 weeks. Country-level differences in improvement were significant (p < 0.001). The program demonstrates that RUTF is a cost-effective short-term preoperative nutritional intervention, at approximately $25 USD per patient through partnership arrangements.

STUDY TYPE

cohort

SPECIALTY

pediatrics

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ORIGINAL PAPER

PMC10012294

The effect of short-term preoperative nutritional intervention for cleft surgery eligibility

BMC Nutrition

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ABSTRACT

Abstract Background Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. Methods A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). Results A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% ( n = 157) of patients were diagnosed with severe, 21.0% ( n = 117) moderate, and 50.7% ( n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) ( p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country( p < 0.001). Conclusion Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-023-00704-1. Keywords: Orofacial clefts, Cleft lip and palate, Pediatrics, Malnutrition, Low- and middle- income countries, Ready-to-use therapeutic foods

CITATION EXPORT

Shady Mikhail, Lily Chattopadhyay, Melissa DiBona et al.. The effect of short-term preoperative nutritional intervention for cleft surgery eligibility. BMC Nutrition. (2023). https://doi.org/10.1186/s40795-023-00704-1

AUTHORS

14 · 9 CENTRES

Shady Mikhail, Lily Chattopadhyay, Melissa DiBona, Charlotte Steppling, Dede Kwadjo, Anjaramamy Ramamonjisoa, Wendy Gallardo, Fatima Almendarez, Beau Sylvester, Samanta Rosales, Ibrahim Nthalika, Zachary J Collier, William Magee, Allyn Auslander

1Operation Smile, Inc, 3641 Faculty Blvd, Virginia Beach, VA 23453 USA
2Children’s Hospital Los Angeles, Los Angeles, CA USA
3Operation Smile Ghana, Accra, Ghana
4Operation Smile Madagascar, Antananarivo, Madagascar
5Operation Smile Venezuela, Caracas, Venezuela
6Operation Smile Nicaragua, Managua, Nicaragua
7Operation Smile Honduras, Tegucigalpa, Honduras
8Operation Smile Malawi, Lilongwe, Malawi
9California Division of Plastic & Reconstructive Surgery, University of Southern, Los Angeles, CA USA