The Benefits of Short-Term Preoperative Nutritional Intervention for Cleft Surgery Eligibility

Abstract Background: Children with orofacial clefts (OFCs) are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for children with malnutrition; however, the effectiveness of short-term preoperative nutritional supplementation in in patients with OFCs has not been demonstrated. We studied the effectiveness of RUTF in patients with OFCs prior to surgery. Methods: A cohort of patients with OFC from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela was followed by Operation Smile from June 2017 to January 2020. These patients were enrolled in a nutrition program that provided RUTF and tracked age, weight, and length/height at each visit. A WHO Weight-for-Length (WLZ) or Weight-for-Height (WHZ) Z-score was calculated for each patient to longitudinally track malnutrition status. Patients were tracked to being sufficiently nourished (Z >= -1) with a secondary outcome of receiving surgery. Results: A total of 556 patients were recruited between June 2017 and January 2020. Initially, 28.2% (N=157) were diagnosed with severe, 21.0% (n=117) with moderate, and 50.7% (n=282) with mild malnutrition. 324 (58.3%) patients presented for at least one return visit. Of the 324 patients who returned, 207 (63.7%) reached optimal nutrition status– 32 (15.5%) with initial severe, 30 (14.5%) with moderate, and 145 (70.0%) with mild malnutrition. By the second visit, the mean z-score increased significantly from -2.5 (moderate malnutrition) to -1.7 (mild malnutrition) (p<0·001). The mean time to attain Z >= -1 was 6 weeks with a range of 1 to 103 weeks. There was a significant difference by country in the proportion of patients who improved (p<0.001). Conclusion: Malnutrition prevents many children with OFC from receiving surgical care even when provided for free creating a larger disparity in access to surgery. In an average of 6 weeks and approximately $25 USD per patient, RUTF supported over 60% of patients to nutritionally healthy and eligible for surgery, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired OFC receive timely and safe surgical care.