Cleft Lip and Palate in Infants With Prenatal Opioid Exposure

Objective: This study examines phenotypic presentation and perioperative outcomes of cleft-related procedures for infants with cleft lip and/or palate (CL/P) and prenatal opioid exposure. Design: This is a retrospective review of infants with prenatal opioid exposure treated for CL/P from 2008 to 2018. Setting: Patients cared for at a tertiary center from 2008 to 2018. Patients/Participants: Eighteen patients with documented prenatal opioid exposure and CL/P had primary repairs in our unit. Main Outcome Measure(s): The phenotypes of CL/P were characterized. Demographic data regarding additional exposures, as well as associated medical and social comorbidities were recorded. Outcome variables included operative delays, perioperative complications, and loss of follow-up. Results: Isolated cleft palate (CP; 67%) was overrepresented among patients with prenatal opioid exposure and CL/P, as was Robin sequence (50% in isolated CP). Fifty-six percent had exposure to additional substances. A majority (67%) had other medical conditions or anomalies, and 17% had known genetic syndromes. Seventy-two percent were in state custody. Thirty-nine percent of exposed patients had delays in their planned operative dates due to medical and/or social factors. There were no postoperative readmissions following cleft procedures. Lack of follow-up was noted in 33% of patients. Conclusions: Infants with CL/P who have prenatal opioid exposure are likely to have additional medical conditions and complex social challenges.