Increased Endocrine Dysfunction in Children With Cleft Lip and Palate: A National Analysis of Pediatric Hospitalizations

Objective To characterize the prevalence, spectrum, and healthcare burden of endocrine disorders across distinct orofacial cleft (OFC) phenotypes and to evaluate the impact of endocrine comorbidity on healthcare utilization and hospital outcomes. Design Retrospective cross-sectional analysis of nationally representative inpatient data. Setting United States hospitals included in the Kids’ Inpatient Database (KID) for 2016, 2019, and 2022. Participants Pediatric hospitalizations identified in the KID. Admissions involving isolated cleft were identified using ICD-10-CM codes and stratified by syndromic status. Interventions None. Main Outcome Measures The primary outcome was the presence of endocrine disorders (including hypothalamic, pituitary, thyroid, parathyroid, adrenal, metabolic, nutritional, and growth abnormalities). Secondary outcomes included length of stay (LOS), total hospital charges, and in-hospital mortality. Results A total of 41 771 OFC hospitalizations were identified (5006: cleft Lip—CL, 18 109: cleft palate—CP, and 18 536: cleft lip and palate). Endocrine disorders were more common among children with OFCs than among noncleft controls (8.3% vs 6.0%, p < .001). Disease burden varied significantly across cleft phenotypes, with CP conferring the highest odds of any endocrine disorder (adjusted odds ratio: 2.68, p < .001). Hypothalamic–pituitary disorders showed strong associations with all cleft phenotypes (all p < .001). Most associations persisted among patients without recognized syndromic diagnoses. Among children with OFCs, endocrine comorbidity was independently associated with a 131% increase in LOS, a 116% increase in total charges, and a 43% increase in in-hospital mortality (all p ≤ .003). Conclusions Despite substantial heterogeneity across cleft types, endocrine dysfunction may be a clinically significant but underrecognized comorbidity in children with OFCs and is associated with increased healthcare utilization, even among nonsyndromic patients.