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Meta-Analysis
. 2011 Feb 16;2011(2):CD003315.
doi: 10.1002/14651858.CD003315.pub3.

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate

Alyson Bessell  1 , Lee Hooper, William C Shaw, Sheena Reilly, Julie Reid, Anne-Marie Glenny
Affiliations
Meta-Analysis

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate

Alyson Bessell et al. Cochrane Database Syst Rev. .

Abstract

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: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies.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: Five RCTs with a total of 292 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 (two studies). 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 difference was shown for infants fitted with a maxillary plate compared to no plate. However, there was some evidence of an effect on weight at 6 weeks post-surgery in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% confidence interval 0.20 to 0.74).

Authors' 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 breastfeeding is better than spoon-feeding following surgery for cleft. There was no evidence to suggest that maxillary plates assist growth in babies with clefts of the palate. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Forest plot of comparison: 1 Rigid versus squeezable bottle, outcome: 1.1 Weight (kg).
3
3
Forest plot of comparison: 1 Rigid versus squeezable bottle, outcome: 1.2 Length (cm).
4
4
Forest plot of comparison: 1 Rigid versus squeezable bottle, outcome: 1.3 Head circumference (cm).
5
5
Forest plot of comparison: 3 Maxillary plate versus no plate, outcome: 3.1 Weight (kg).
6
6
Forest plot of comparison: 3 Maxillary plate versus no plate, outcome: 3.2 Length (cm).
1.1
1.1. Analysis
Comparison 1 Rigid versus squeezable bottle, Outcome 1 Weight (kg).
1.2
1.2. Analysis
Comparison 1 Rigid versus squeezable bottle, Outcome 2 Length (cm).
1.3
1.3. Analysis
Comparison 1 Rigid versus squeezable bottle, Outcome 3 Head circumference (cm).
2.1
2.1. Analysis
Comparison 2 Breastfeeding versus spoon‐feeding, Outcome 1 Weight (kg).
2.2
2.2. Analysis
Comparison 2 Breastfeeding versus spoon‐feeding, Outcome 2 Duration of hospital stay (days).
3.1
3.1. Analysis
Comparison 3 Maxillary plate versus no plate, Outcome 1 Weight (kg).
3.2
3.2. Analysis
Comparison 3 Maxillary plate versus no plate, Outcome 2 Length (cm).
3.3
3.3. Analysis
Comparison 3 Maxillary plate versus no plate, Outcome 3 Head Circumference (cm).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Brine 1994 {published data only}
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    1. Masarei AG, Sell D, Habel A, Mars M, Sommerlad BC, Wade A. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Cleft Palate‐Craniofacial Journal 2007;44(3):321‐8. - PubMed
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References to studies excluded from this review

Bongaarts 2009 {published data only}
    1. Bongaarts CA, Prahl‐Andersen B, Bronkhorst EM, Prahl C, Ongkosuwito EM, Borstlap WA, et al. Infant orthopedics and facial growth in complete unilateral cleft lip and palate until six years of age (Dutchcleft). Cleft palate‐Craniofacial Journal 2009;46(6):654‐63. - PubMed
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