Risk of pneumonia among children with cleft palate before and after palatoplasty: a population-based study

Abstract

Pneumonia remains the primary cause of mortality among children under age 5. Cleft palate (CP) poses various challenges including velopharyngeal disfunction, potentially increasing rates of pneumonia. However, clinical evidence linking pneumonia to defect is lacking. This study aims to assess the prevalence of pneumonia and lower respiratory tract infections (LRTI) among CP patients through a population-based approach. This retrospective cohort study was conducted using medical records from Clalit Health Services in Israel, 2013–2022, encompassing population of 138,261 infants, including 166 with CP. We investigated the prevalence of pneumonia and other infectious diseases before and after palatoplasty, employing Poisson regression models adjusted for multiple demographic and clinical variables. A sibling comparison study was also conducted, analyzing 129 preoperative and 55 postoperative pairs. The preoperative analysis revealed an increased risk of pneumonia (relative risk [RR]: 5.8, 95% confidence interval (CI): 3.93–8.19), lower respiratory tract infections (LRTI) (RR: 1.55, 95% CI: 1.12–2.06), and urinary tract infections (UTI) (RR: 5.27, 95% CI: 3.23–8.03) in children with CP compared to controls. Following surgical repair, a statistically significant but reduced risk for pneumonia persisted up to 5 years (RR: 2.55, 95% CI: 1.59–3.84). Sibling comparison analyses underscored an elevated pneumonia risk compared to CP siblings preoperatively (RR: 7.07, 95% CI: 2.48–29.8). Postoperatively, the RR decreased and was no longer statistically significant (RR: 1.44, 95% CI: 0.49–4.75). Conclusion: Patients with CP are at higher risk for pneumonia, and the magnitude of risk may be reduced after palatoplasty. What is Known:• Cleft palate (CP) disrupts the separation of the nasal and oral cavities, leading to food regurgitation into the nasal cavity and theoretically may lead to respiratory tract infections.• The association between CP and respiratory tract infections has yet to be assessed thoroughly. What is New:• This population-based study has shown that CP is an independent risk factor for pneumonia.• The risk for pneumonia among CP patients is lowered after surgical repair of the defect.