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Background
Patterns of growth in children with a cleft palate have not been well delineated in the literature. This study describes the pattern of growth in non-syndromic children before and after cleft palate repair at a major American cleft referral.
Methods
A chart review was performed to identify all patients who underwent palate repair between 2010 and 2013. Syndromic patients and those with secondary or submucosal repairs were excluded. Patients were categorized as internationally adopted or domestic. Growth measurements were abstracted from the electronic medical record. Length, weight, and head circumference were converted to z-scores for age according to World Health Organization’s (WHO) standards. Three time periods were identified: birth, pre-cleft palate repair and post- repair (up to 2 years post-surgery). A growth model was fit to standardized anthropometric data, with time as a discrete variable and a random effect at the patient level. For each measure, contrasts were calculated between each of the three time periods separately for adoptees and domestic children. P-values were not adjusted for multiple comparisons.
Results
We obtained 633 lengths, 720 weights, and 291 head circumferences from 22 international adoptees and 107 domestic children (47% female). Adoptees were significantly older at surgery, mean age 24.0 months, than the domestic children, 10.8 months (p <0.001). At birth, z-scores for weight in both groups were negative (below average anthropometrics). The z-scores for weight declined from birth to pre-repair among both domestic children and adoptees (p < 0.001, and p = 0.079, respectively), and rebounded significantly after repair (p < 0.001 domestic, p = 0.001 adoptees). Length z-score also declined significantly in both groups from birth to pre-repair, and increased pre- to post-repair (p-values all < 0.05). Head circumference post-repair increased significantly in the domestic group (p < 0.001), but not in the adoptees (p = 0.449), whose mean z-score remained over a standard deviation below normal.

	Domestic			Adoptee
Measurement (z-score)	N	Mean	S.D.	N	Mean	S.D.	p-value
Weight at birth	98	-0.2	1.2	9	-0.3	1.1	0.637
Weight-for-age pre-repair	91	-0.8	1.2	17	-0.9	1.0	0.721
Weight–for-age post-repair	77	0.2	0.9	19	-0.1	0.9	0.023
Length at birth	28	0.3	1.7	9	-0.0	0.9	0.177
Length-for-age pre-repair	87	-0.8	1.4	17	-1.6	1.3	0.055
Length-for-age post-repair	76	-0.5	1.3	18	-0.7	1.2	0.253
Head Circumference at birth	15	-0.1	1.1	9	-0.3	1.1	0.069
Head circ.-for-age pre-repair	34	-0.3	1.3	16	-1.2	0.9	0.004
Head circ.-for-age post-repair	21	0.7	1.2	6	-1.2	0.6	0.000

Conclusions
Cleft palate children, on average, weigh less at birth than normal. Unrepaired infants remain small for age until palate repair, but rebound following surgery. While palate repair in international adoptees occurs significantly later, their weight and length rebound similarly. Head circumference is the one measure for which adoptees to do not catch up. This discrepancy merits further study.