Cleft palate & lip

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Specializes in Level 3 NICU 17 yrs, Neo transport 13 yr.

We have a 25 week twin that has a cleft palate and lip. He is intubated now, but everyone is trying to figure out how to manage him after extubation. He basically has no left nare and we are unable to pass a tube through the right nare. Has anyone out there experienced this? What can be done for a CPAP type apparatus?

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Specializes in Neonatal ICU (Cardiothoracic).
We have a 25 week twin that has a cleft palate and lip. He is intubated now, but everyone is trying to figure out how to manage him after extubation. He basically has no left nare and we are unable to pass a tube through the right nare. Has anyone out there experienced this? What can be done for a CPAP type apparatus?

If he has a patent left nare (even if it's small) he might be ok with a nasal mask.

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How frequent are cleft palates/lips occur these days? Also how soon can a baby with a cleft palate and/or lip have it repaired?

Kris

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Specializes in Neonatal ICU (Cardiothoracic).

I've seen one or two a year.... they usually wait until 3-12 months old to start repairing them. depends on the level of severity, and whether it's just a cleft lip, cleft palate, or both, or if there's nasal involvement. Also depends if its a single or double cleft. Their length of stay in NICU usually depends on how long it takes to get them to nipple effectively. I've seen kids go home in 2 days to wait to get big enough for surgery.

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Specializes in NICU.

I've seen LMAs used in cleft palate kids, but my understanding is that they're not used everywhere. You can do CPAP with an LMA, though, which is nice.

Laryngeal Mask Airway

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My son was a 27 weeker born with a bilateral cleft lip and palate. They kept him on an oscillator until he was able to move to a high-flow nasal cannula and did wonderful on that. They were also considering a method a doctor had heard about in the UK with an oxygen mask secured to the face, a hat, a kind of rigged CPAP. Since doing a regular CPAP won't work.

The lip repair is usually done when the baby hits 10 pounds. Rule of 10's: 10 pounds, 10 weeks, 10 g hemoglobin. They'll also put in a palate prosthesis then. When the baby is about a year old (adjusted) they'll do the soft palate repair. The hard palate and bone graft is done ages 4+. And the other question, about 1 in 750 babies born have a cleft lip/palate.

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Specializes in Level 3 NICU 17 yrs, Neo transport 13 yr.

Thanks Loralai. That is the type of apparatus that our doctors are talking about putting together. The LMA has also been mentioned.

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Specializes in Neonatal ICU (Cardiothoracic).

Most NCPAP manufacturers make a nasal mask that works with existing CPAP drivers. You may not have to rig anything up if you can get one... I KNOW Infant Flow makes one...

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