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Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate
A M Glenny1, L Hooper, W C Shaw
1Cochrane Oral Health Group, MANDEC, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH. a.glenny@man.ac.uk
Insights
Feeding interventions for babies with cleft lip and/or palate show no significant growth differences between bottle types. Breastfeeding may offer a slight weight advantage over spoon-feeding post-surgery.
Area of Science:
- Pediatric surgery
- Neonatology
- Craniofacial anomalies
Background:
- Cleft lip and palate affect approximately 1 in 700 newborns.
- Infants with clefts often experience feeding difficulties and delayed growth.
- Interventions aim to improve feeding and support growth in these infants.
Purpose of the Study:
- To evaluate feeding interventions for infants with cleft lip and/or palate.
- To assess the impact on infant growth, development, and parental satisfaction.
- To synthesize evidence from randomized controlled trials (RCTs).
Main Methods:
- Systematic review of RCTs comparing feeding interventions.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED.
- Included studies of infants up to 6 months with cleft lip, palate, or both.
Main Results:
- Four RCTs involving 232 infants were analyzed.
- No significant growth differences were found between squeezable and rigid feeding bottles.
- Breastfeeding showed a statistically significant weight gain advantage over spoon-feeding at 6 weeks post-surgery.
Conclusions:
- Squeezable bottles may be easier to use but do not improve growth outcomes compared to rigid bottles.
- Limited evidence suggests breastfeeding is beneficial for infant weight gain after cleft lip surgery.
- Further research is needed on maternal advice and support strategies.
Background:
Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts.
Objectives:
This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction.
Search Strategy:
We searched the Cochrane Oral Health Group's Trials register (June 2001), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to May 24th 2004), EMBASE (1980 to August 7th 2002), CINAHL (1982 to August 7th 2002), PsychINFO (1967 to August 13th 2002), AMED (1985 to August 13th 2002). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication.
Selection Criteria:
Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term).
Data Collection And Analysis:
Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible.
Main Results:
Four RCTs with a total of 232 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (one study). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No statistically significant difference was shown for infants fitted with a maxillary plate compared to no plate. A statistically significant difference in weight (kg) at 6 weeks post-surgery was shown in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% CI: 0.20, 0.74).
Reviewers' Conclusions:
Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that babies should be breastfed rather than spoon-fed following surgery for cleft lip. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.
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