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Howell HM, Galarza LI, Humphries LS, Hoppe IC. Cleft Lip Repair Comparison Between Inpatient and Outpatient Surgeries: A Multi-Surgeon Experience. Cleft Palate Craniofac J 2024:10556656241278569. [PMID: 39196655 DOI: 10.1177/10556656241278569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024] Open
Abstract
OBJECTIVE Great variability exists as to whether cleft lip (CL) repair is performed as an inpatient or outpatient surgery. This study's aim is to investigate the authors' institutional experience to see if there is an increase in complications, emergency department (ED) visits, or readmissions to the hospital when performed as outpatient. DESIGN This study reviewed patients who underwent CL repair between 2012 and 2023 at the authors' institution. Data collected included patient demographics, perioperative details, ED visits and readmissions within thirty days of surgery, and complications. RESULTS One hundred forty-five patients met inclusion measures. When the surgery was performed as outpatient, there was no significant difference in returning to the ED (p = 0.767) or readmission to the hospital (p = 0.447) within thirty days as compared to inpatient surgeries. Outpatients did not have more postoperative complications (p = 0.698). Bilateral cleft lips were more likely to be performed as inpatient (p = 0.001). Inpatients had a lower weight at time of repair (p = 0.033). Patients with a respiratory (p = .006), gastrointestinal (p = 0.003), or hematologic (p = 0.013) comorbidity had a higher readmission rate. Patients were more likely to be readmitted if they had a younger gestational age (p = 0.005). CONCLUSION There was no increased return to the ED or readmission for patients undergoing inpatient versus outpatient CL repair. CL repair can be performed safely in an outpatient setting with careful patient selection.
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Affiliation(s)
- Haven M Howell
- University of Mississippi School of Medicine, Jackson, MS, USA
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Division of Plastic and Reconstructive Surgery, Children's of Mississippi, Jackson, MS, USA
| | - Laura I Galarza
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Division of Plastic and Reconstructive Surgery, Children's of Mississippi, Jackson, MS, USA
| | - Laura S Humphries
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Division of Plastic and Reconstructive Surgery, Children's of Mississippi, Jackson, MS, USA
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Division of Plastic and Reconstructive Surgery, Children's of Mississippi, Jackson, MS, USA
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Stanton E, Roohani I, Shakoori P, Fahradyan A, Urata MM, Magee WP, Hammoudeh JA. Comparing Outcomes of Traditional Lip Repair Versus Early Cleft Lip Repair on a National Scale. Ann Plast Surg 2024; 92:194-197. [PMID: 38198627 DOI: 10.1097/sap.0000000000003771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cleft lip (CL) is one of the most common congenital anomalies and has traditionally been repaired surgically when the patient is between 3 and 6 months of age. However, recent single-institutional studies have demonstrated the efficacy and safety of early CL repairs (ECLRs) during the neonatal period. This study seeks to evaluate the outcomes of ECLR (repair <1 month) versus traditional lip repair (TLR) by comparing outcomes on a national scale. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric Date File was used to query patients who underwent CL repairs between 2012 and 2022. The main outcome measures were anesthesia times and perioperative complications. The main predictive variable was operative group (ECLR vs TLR). Patients were considered to be in the ECLR cohort if they were younger than 30 days after birth at the time of cleft repair. Student t test and χ2 analyses were used to evaluate categorical and continuous differences, respectively. Multiple logistic regression was performed to model the association of ECLR versus TLR with death within 30 days, overall complication rates, dehiscence rates, readmission within 30 days, and reoperation rates while controlling for various covariates. RESULTS Multiple linear regression determined that the ECLR cohort had significantly shorter operative times when controlling for operative complications, sex, cardiac risk factors, and American Society of Anesthesiologists class (coefficient = -34.4; confidence interval, -47.8 to -20.9; P < 0.001). Similarly, multiple linear regression demonstrated ECLR patients to have significantly shorter time of exposure to anesthesia (coefficient = -35.0; 95% confidence interval, -50.3 to -19.7; P < 0.001). Multiple logistic regression demonstrated that ECLR was not significantly associated with an increased likelihood of any postoperative complication when controlling for sex, cardiac risk factors, and American Society of Anesthesiologists class (P = 0.26). CONCLUSIONS The findings of this study provide nationwide evidence that ECLR does not lead to an increased risk of adverse outcomes or complications. In addition, ECLR patients have shorter surgeries and shorter exposure to anesthesia compared with TLR. The results provide further evidence that ECLR can be done safely where earlier intervention may result in better feeding/weight gain and subsequently improve cleft care. However, longer-term studies are warranted to further elucidate the effects of this protocol.
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Affiliation(s)
| | | | | | - Artur Fahradyan
- From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
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Roohani I, Trotter C, Shakoori P, Moshal TA, Lasky S, Manasyan A, Wolfe EM, Magee WP, Hammoudeh JA. Lessons Learned from a Single Institution's Eight Years of Experience with Early Cleft Lip Repair. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1741. [PMID: 37893459 PMCID: PMC10608426 DOI: 10.3390/medicina59101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution's ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children's Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.
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Affiliation(s)
- Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Collean Trotter
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Pasha Shakoori
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - Tayla A. Moshal
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Sasha Lasky
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Artur Manasyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Erin M. Wolfe
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
| | - Jeffrey A. Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (I.R.); (T.A.M.); (S.L.); (W.P.M.III)
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA; (P.S.); (E.M.W.)
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Kondra K, Stanton E, Jimenez C, Chen K, Hammoudeh JA. Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care. Ann Plast Surg 2023; 90:S312-S314. [PMID: 37227409 DOI: 10.1097/sap.0000000000003399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. METHODS Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded. RESULTS Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027). CONCLUSIONS Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.
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Affiliation(s)
| | | | | | - Kevin Chen
- From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA
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Kondra K, Stanton E, Jimenez C, Ngo K, Wlodarczyk J, Jacob L, Munabi NCO, Chen K, Urata MM, Hammoudeh JA. Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain. Cleft Palate Craniofac J 2023; 60:306-312. [PMID: 34866435 DOI: 10.1177/10556656211062042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms. DESIGN Retrospective review. SETTING Children's Hospital of Los Angeles, California. PATIENT, PARTICIPANTS A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020. INTERVENTIONS No intervention was performed. MAIN OUTCOME MEASURE(S) Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups. RESULTS 107 patients met inclusion criteria: ECLR, n = 51 (47.6%); TLR + NAM, n = 35 (32.7%); and TLR-NAM, n = 21 (19.6%). ECLR patients had significantly greater changes in weight from surgery to 8-weeks and from surgery to 24-months postoperatively compared with both TLR ± NAM (P < .05). Age-matched weights in the ECLR group were significantly greater than TLR ± NAM at multiple time points postoperatively (P < .05). CONCLUSIONS ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.
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Affiliation(s)
- Katelyn Kondra
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Eloise Stanton
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Christian Jimenez
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Kalvyn Ngo
- 43801Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Jordan Wlodarczyk
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Laya Jacob
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Naikhoba C O Munabi
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
| | - Kevin Chen
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M Urata
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
- 43801Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- 5150Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
- 12223Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA, USA
- 43801Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA
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Ueki S, Fujita A, Kumagai Y, Hirai Y, Tashiro E, Miyata J. Bottle-feeding techniques for children with cleft lip and palate experiencing feeding difficulties. Int J Nurs Sci 2022; 10:82-88. [PMID: 36860720 PMCID: PMC9969066 DOI: 10.1016/j.ijnss.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to identify clinical bottle-feeding techniques practiced by nurses for children with cleft lip and palate experiencing feeding difficulties. Methods A qualitative descriptive design was used. Five anonymous questionnaires were distributed to each hospital, and 1,109 hospitals with obstetrics, neonatology, or pediatric dentistry wards in Japan were enrolled in the survey between December 2021 and January 2022. Participants were nurses working for over 5 years providing nursing care for children with cleft lip and palate. The questionnaire comprised open-ended questions about the feeding techniques across four dimensions: preparation before bottle-feeding, nipple insertion methods, sucking assistance, and criteria for stopping bottle-feeding. The qualitative data obtained were categorized according to meaning similarity and analyzed. Results A total of 410 valid responses were obtained. The findings regarding the feeding techniques in each dimension were as follows: seven categories (e.g., improving child's mouth movement, keeping child's breath calm), 27 sub-categories in preparation before bottle-feeding; four categories (e.g., closing the cleft using the nipple to create negative pressure in oral cavity, inserting the nipple to not touch the cleft), 11 sub-categories in nipple insertion methods; five categories (e.g., facilitating awakening, creating negative pressure in oral cavity), 13 sub-categories in sucking assistance; and four categories (e.g., reduced awakening level, worsening vital signs), 16 sub-categories in criteria for stopping bottle-feeding. Most participants responded that they would like to learn bottle-feeding techniques for children with cleft lip and palate who have feeding difficulties. Conclusion Many bottle-feeding techniques were identified to address disease-characterized conditions. However, the techniques were found to be conflicting: some inserted the nipple to close the cleft to create negative pressure in the child's oral cavity, while others inserted it without touching the cleft to prevent ulceration on the nasal septum. Although these techniques were used by nurses, the effectiveness of the methods has not been assessed. Future intervention studies are needed to determine each technique's benefit or potential harm.
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Affiliation(s)
- Shingo Ueki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan,Corresponding author.
| | - Ayaka Fujita
- School of Nursing, Daiichi University of Pharmacy, Fukuoka, Japan
| | - Yukari Kumagai
- Department of Nursing, Osaka University Dental Hospital, Osaka, Japan
| | - Yumi Hirai
- Department of Nursing, Osaka University Dental Hospital, Osaka, Japan
| | - Eri Tashiro
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junko Miyata
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lopez-Bassols I. Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate. J Hum Lact 2021; 37:419-424. [PMID: 33201761 DOI: 10.1177/0890334420964159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This case presents a mother's feeding experience of an infant born with a complete unilateral cleft lip and palate from birth until both were repaired. She fed him directly at the breast with assistance, controlling the delivery of the mother's own milk. The infant received only his mother's own milk, no bottles, and the excess expressed milk was donated to a milk bank. MAIN ISSUE The Cleft Team supported the mother's wish to breastfeed but expressed realism that cleft lip and palate infants could not create suction. Success had never been observed in the unit. Instead, the team suggested expressing to deliver as much of the mother's own milk. The mother had previously breastfed her three children and was keen on finding innovative ways to breastfeed. MANAGEMENT Several techniques were trialed with the help of an International Board Certified Lactation Consultant. The most sustainable and successful was the use of a nipple shield applied to the maternal nipple areola complex to cover the lip palate. Underneath, a nasogastric tube connected to a syringe delivered the mother's own milk. Exclusive expressing protected maternal supply, the infant's nutrition and growth were monitored carefully and this technique reinforced mother-infant bonding. CONCLUSION Feeding with the modifications was challenging at times. However, maternal satisfaction was high because the mother had achieved her goal of breastfeeding without assistance post cheiloplasty and palatoplasty. This case adds to the limited body of research about feeding infants with cleft lips and palates directly at the breast.
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Burianova I, Cerny M, Borsky J, Zilinska K, Dornakova J, Martin A, Janota J. Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair. Cleft Palate Craniofac J 2020; 58:146-152. [PMID: 32799648 DOI: 10.1177/1055665620949114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. DESIGN This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. SETTING Tertiary neonatal and pediatric surgery center. PATIENTS Hospital A: 61 newborns, Hospital B: 157 newborns. INTERVENTIONS Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. MAIN OUTCOME MEASURES Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. RESULTS Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. CONCLUSIONS The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.
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Affiliation(s)
- Iva Burianova
- Department of Neonatology, 48208Thomayer Hospital, Prague, Czech Republic and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milos Cerny
- Department of Obstetrics and Gynecology/Neonatology, 48359University Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Borsky
- Department of Otorhinolaryngology, 2nd Faculty of Medicine, Charles University, Prague, Faculty Hospital Motol, Czech Republic
| | - Kristyna Zilinska
- Department of Neonatology, 48209Thomayer Hospital, Prague, Czech Republic
| | - Jana Dornakova
- Department of Obstetrics and Gynecology/Neonatology, 48359University Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aisling Martin
- Department of Obstetrics and Gynecology, 8830Coombe Women and Infants University Hospital, University College Dublin, Ireland
| | - Jan Janota
- Department of Neonatology, 48209Thomayer Hospital, Prague and Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Boyce JO, Reilly S, Skeat J, Cahir P. ABM Clinical Protocol #17: Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate-Revised 2019. Breastfeed Med 2019; 14:437-444. [PMID: 31408356 DOI: 10.1089/bfm.2019.29132.job] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Jessica O Boyce
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
- Speech and Language Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sheena Reilly
- Speech and Language Group, Murdoch Children's Research Institute, Melbourne, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Jemma Skeat
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Petrea Cahir
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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