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Erdost ŞK, Gözen D. The effect of position on feeding performance in infants with cleft lip and palate: Quasiexperimental study. J SPEC PEDIATR NURS 2024; 29:e12428. [PMID: 38800888 DOI: 10.1111/jspn.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This single-group, quasiexperimental study was conducted to determine the effect of feeding position on the physiological parameters and feeding performance of term-born infants with cleft lip and palate (CLP) in the preoperative period. METHODS The study sample consisted of 45 infants aged 0-6 months with CLP followed up preoperatively in our outpatient clinic between January 2021 and 2022. Infants who were being fed with a specialty bottle for babies with CLP and whose families consented to participate in the study were included. After 2 h of fasting, the infants were fed in the elevated supine (ESU) position for the first meal, then in the elevated side-lying (ESL) position for the second meal after another 2 h of fasting. The infants' heart rate and oxygen saturation values before, during, and after each feed and indicators of feeding performance were compared between the positions. RESULTS There was no significant difference between the positions in terms of heart rate and oxygen saturation before, during, or after feeding (p > .05). There was no statistically significant difference in measures of feeding performance according to the infants' feeding position (p > .05). CONCLUSION According to the findings obtained in this study, infants with CLP showed no statistically significant differences in heart rate, oxygen saturation, or feeding performance when fed in the ESL and ESU positions. PRACTICE IMPLICATIONS However, despite the lack of statistical significance, both physiological values and feeding performance tended to be better when the infants were fed in the ESL position, nurses can practice ESL position according to the infant's opposite direction of the side of the cleft lip or palate.
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Affiliation(s)
- Şerife Kartal Erdost
- Health Science Faculty, Department of Nursing, İstanbul Kültür University, Istanbul, Turkey
| | - Duygu Gözen
- Pediatric Nursing, School of Nursing, Koç University, Istanbul, Turkey
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Prezelski K, Villarreal Acha D, Ngo TVC, Wilson C, Thrasher V, Trevino K, Van't Slot C, Hallac RR, Seaward JR, Kane AA. A Dedicated Multidisciplinary Growth and Feeding Clinic for Infants with Cleft Lip and/or Palate Demonstrates Need for Intervention. Cleft Palate Craniofac J 2024:10556656241258687. [PMID: 38860332 DOI: 10.1177/10556656241258687] [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: 06/12/2024] Open
Abstract
OBJECTIVE A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented. DESIGN This study assessed the effect of preoperative feeding interventions provided by the GFC. SETTING Tertiary academic center. METHODS This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than -2.00 was used as a cutoff to classify patients who were underweight during the preoperative period. MAIN OUTCOME MEASURE The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure. RESULTS Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits (P < .001) and GFC interventions (P < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients (P = .0187). CONCLUSION This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.
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Affiliation(s)
- Kayla Prezelski
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Daniel Villarreal Acha
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tuong-Vi Cindy Ngo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin Wilson
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Vania Thrasher
- Department of Clinical Nutrition, Children's Health, Dallas, TX, USA
| | - Kandi Trevino
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Cortney Van't Slot
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
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Kotlarek KJ, Benson M, Williams J. Current Practice Patterns and Training Pathways for Feeding Infants with Cleft Palate. Cleft Palate Craniofac J 2024; 61:1018-1026. [PMID: 36683489 DOI: 10.1177/10556656231152358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To examine the current trends and practices across disciplines for feeding infants with cleft palate with or without cleft lip and to describe provider training within this area. DESIGN Prospective survey. SETTING ACPA approved cleft palate teams and healthcare providers in the United States and Canada. PARTICIPANTS Interdisciplinary providers that regularly provide feeding services to infants with cleft palate. INTERVENTION 50-item survey designed and distributed electronically via the ACPA. MAIN OUTCOME MEASURES Information on provider demographics and practice patterns. RESULTS 76 respondents included providers in North America that have either currently or previously served on a cleft palate team. The majority of respondents were in speech-language pathology (49%) or nursing (38%) disciplines, worked in an outpatient setting (70%), and received no information (68%) regarding cleft palate feeding in their academic training. While specific practice patterns were relatively consistent across the respondent cohort, provider characteristics were significantly associated with squeezing the Haberman (p = .013) and likelihood of collaboration with other providers when counseling parents/caregivers (p = .039). CONCLUSIONS While provider characteristics varied, there were similar practice patterns observed across disciplines. Future research is needed explore training related to feeding knowledge as well as practice patterns in locations with a lower patient volume.
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Affiliation(s)
- Katelyn J Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Mikayla Benson
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Jessica Williams
- Phoenix Children's Center for Cleft and Craniofacial Care, Phoenix, AZ, USA
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
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Tahmasebifard N, Briley PM, Ellis C, Perry JL. Early Nutrition among Infants Admitted to the NICU with Cleft Lip and Palate. Cleft Palate Craniofac J 2023; 60:299-305. [PMID: 34812064 DOI: 10.1177/10556656211059371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to examine differences in human milk feeding outcomes among infants admitted to a neonatal intensive care unit (NICU) with and without cleft lip and palate (CLP). METHOD Data were used from a sample of infants admitted to the NICU with and without CLP from the 2018 National Vital Statistics System. For baseline comparisons, Chi-square tests of independence were used to compare categorical variables, and independent samples t tests were used for continuous variables. Logistic regression models were performed to determine the odds of human milk feeding at discharge in infants admitted to the NICU with CLP. RESULTS The total sample included 345,429 infants admitted to the NICU, of which 660 had CLP. Significant differences were found among the following variables when baseline comparisons were made between infants admitted to the NICU with and without CLP: mother's race, mother's education, maternal smoking record, childbirth delivery method, presence of maternal pre-pregnancy diabetes, five-minute APGAR score, multiparity record (having more than one baby at birth), gestational age, and gestational weight. After controlling for baseline differences, results indicated reduced odds of human milk feeding at discharge in infants admitted to the NICU with CLP compared to those without CLP (OR = .543; 95% CI.455,.648). CONCLUSION Results suggest reduced odds of human milk feeding at discharge among infants admitted to the NICU with CLP compared to those without CLP. These findings emphasize the necessity of awareness and facilitation of human milk feeding in this population.
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Affiliation(s)
- Neda Tahmasebifard
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, USA
| | - Patrick M Briley
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, USA
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, USA
| | - Jamie L Perry
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, 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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Penny C, McGuire C, Bezuhly M. A Systematic Review of Feeding Interventions for Infants with Cleft Palate. Cleft Palate Craniofac J 2021; 59:1527-1536. [PMID: 34714161 DOI: 10.1177/10556656211051216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. METHODS A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. RESULTS Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. CONCLUSIONS Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.
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Affiliation(s)
- Cameron Penny
- 12361Dalhousie University, Halifax, Nova Scotia, Canada
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