Commentary of Early Weight Gain in Infants With Cleft Lip and Palate Treated With and Without Nasoalveolar Molding: A Retrospective Study

Appropriate feeding and consequent adequate weight gain are one of the first concerns about any infants after birth. Not only in the newborn but as a physiological process, feeding requires perfect coordination of breathing, sucking, and swallowing (Merrow, 2016). This ability is easily disturbed by any neurological or anatomical distress. Feeding disorders include prolonged feeding times, reduced oral intake, unsafe oral feeding, and precipitation of respiratory decompensation (da Silva Freitas et al., 2012). The incidence of feeding problems in infants with craniofacial malformation is high, and in cleft lip/palate rates vary from 25% to 73% (Wiechers et al., 2020). The utilization of palatal plates has been advocated as an adjuvant for the treatment, facilitating suction and even helping the palatal arch remodeling (Phral et al. 2005). In a study performed in our center in 2012, we realized that patients with cleft have a decreased weight gain in comparison to healthy infants; however, at the end of the first year of life, this difference disappeared (da Silva Freitas et al., 2012). Palatal plates are not a standard of care in our center for any patients; however, some measures are strictly advised: support, education, integrated multidisciplinary care, and regular follow-up. When reading the paper entitled “Early Weight Gain in Infants with Cleft Lip and Palate Treated with and without nasoalveolar molding: A Retrospective Study,” we question the initial statement in third paragraph in the introduction: “it should be determined whether treatment involving the NAM appliance poses a burden on weight gain in infants with CL þ P.” As authors firstly emphasize, the proposed benefits of presurgical infant orthopedics includes facilitation of feeding. Then, they cite some previous studies that did not show positive benefits in weight gain of the patients with cleft that used nasoalveolar molding compared to standard care (Woods et al., 2019). The intention of the present study was to verify whether the utilization of the nasoalveolar appliance could be related as a negative factor in weight gain of the patients. They concluded that nasoalveolar molding showed greater weight gain curves, although the exact cause of this finding could not be related to NAM utilization. There is a question about the follow-up: the original paper (Woods et al., 2019) demonstrated the same evolution of weight gain until 1 year of age in both group (NAMþ and NAM ). Palate repair generally is performed at 12 months. Why did they decide to extend weight gain measurements until 36 months old? What should be the benefit of measure weight gain in NAMþ patients after 12 months after birth? What could the influence NAM have after stopping its use? In our point of view, there are questions about the strict need of parent’s compliance, the increased costs and morbidity (as sometimes sedation and anesthesia are necessary for appliance insertion and removal) (Grayson and Garfinkle, 2014), and the possibility of local tissue irritation and relapse of previous deformity (Retnakumari et al., 2014). All these potential disadvantages should be overlapped by a great enhancement in both cleft deformity and well-being of patients, including weight gain.