Complete cleft lip and palate in a preterm infant: An airway management challenge on a neonatal unit

Prematurity combined with bilateral cleft lip and palate presents significant challenges in airway and respiratory management. This case report shares the experience of a neonatal intensive care unit (NICU) team where an instance of unplanned extubation challenged the team to consider solutions in supporting the airway, where standard non-invasive ventilation equipment was unsuitable due to the baby’s facial anatomy. The case focuses on the difficulties encountered, the innovative solutions implemented and the key lessons learned from this experience.

Dr Hannah Rogers
Paediatric Registrar ST5

Dr Sanjeev Rath
Consultant Neonatal Paediatrician

Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust

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Keywords

cleft lip and palate; prematurity; respiratory management

Key points

Prematurity combined with bilateral cleft lip and palate presents significant challenges in airway and respiratory management.
Managing a preterm baby with bilateral cleft lip and palate requires understanding of complex facial anatomy and addressing the associated airway management challenges.

Also published in Infant:

VOLUME 18 ISSUE 2/MARCH 2022

LCHAD deficiency and extreme prematurity: challenging aspects of nutritional management

In this article we present the case of an extremely preterm female infant who was born at 22⁺⁵ weeks’ gestation following an antepartum haemorrhage. A postnatal genetic diagnosis of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency was made. LCHAD deficiency is a complex metabolic condition, which can be even more challenging to treat when combined with extreme prematurity. Using specialised milk formulas in an extremely preterm infant was a difficult decision; this case report aims to highlight such nutritional and metabolic challenges.