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Title No Significant Feeding Aids/Interventions Have Been Determined to Positively Affect Growth Patterns of Babies With Orofacial Clefts
Clinical Question Are there any feeding aids/interventions that help to maintain growth and development in children with cleft lip and/or palate?
Clinical Bottom Line Three feeding aids/interventions were tested: squeezable vs. rigid feeding bottles, breastfeeding vs. spoon-feeding, and the use or no use of a maxillary plate. No significant improvement in growth was found in the comparison groups.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21328261Bessell / 2011Studies reviewed are randomized controlled trials. Patient group: babies with orofacial clefts up to 6 months of age. Exclusion criteria: Pierre Robin sequence and other syndromes.Cochrane Database Systematic Review
Key resultsDependent variables are growth, development, and parental satisfaction. Generally, babies with clefts tend to be lighter in weight and smaller due to difficulties with feeding. This necessitates the need to find feeding aids/interventions to improve growth of babies with clefts. The first comparison was squeezable vs. rigid feeding bottles (Brine 1994; Shaw 1999). No difference in growth measurements at any time point was found. The amount of modification required for the rigid bottle by a health visitor was 48% vs. 8% for the squeezable bottle (p <0.05). The second comparison was breastfeeding vs. spoon-feeding (Darzi 1996). Breastfeeding at 6-weeks post-surgery favored larger weight (mean difference 0.47). The third comparison was the use of a maxillary plate vs. no plate use (Prahl 2005; Masarei 2007). Use of the plate showed a statistically significant difference in weight at the 6 month time period only. Statistically significant differences were not seen with regard to length or head circumference.
Evidence Search ("Cleft Lip"[Mesh] AND "Cleft Palate"[Mesh]) AND "Therapeutics"[Mesh] AND ((Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp]) AND systematic[sb])
Comments on
The Evidence
To fill in "missing data”, the authors of the articles were contacted to clarify any confusion. Eight studies were included in the systematic review. Four studies had low risk bias due to randomization ((Darzi 1996; Shaw 1999; Prahl 2005; Masarei 2007)). Blinding was not an option to parents providing treatment intervention. A confounding variable: compliance with utilization of the maxillary plate. Follow up length of the studies was not sufficient, the adequate follow up should be until 2 years of age for better accuracy to include confounding variables such as the effect of surgery.
Applicability This information is useful to parents of babies born with orofacial clefts as well as the health care providers treating these patients.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Prosthodontics)
Keywords cleft lip and palate, feeding aids/interventions, treatment, orofacial clefts
ID# 2143
Date of submission: 09/16/2011spacer
E-mail dominessy@livemail.uthscsa.edu
Author Cynthia Dominessy, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Maria Mendez-Cervantes, DDS
Faculty mentor/Co-author e-mail CervantesMen@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by David Hoeks, Vincent Vo (San Antonio, TX) on 11/28/2017
A PubMed search was conducted on 11/26/2017 and a more recent article was found: Rowicka 2014, PMID 25171629. This article references other studies that support the conclusions stated in this CAT. First, there is controversy with the use of palatal plates, and therefore their use is not recommended. Second, no significant difference in growth was found between bottle and spoon feeding, so bottle feeding is recommended as the simpler method. Lastly, nutrition alterations/supplementations are recommended to further support growth, as well as the use of a naso-gastric feeding tube if needed to improve growth.

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