Intervensi pemberian makanan untuk pertumbuhan dan pembentukan bayi dengan bibir terbelah, lelangit terbelah atau bibir dan lelangit terbelah.
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 methods
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 Attempts were made to identify both unpublished and ongoing studies.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.
PICO
Plain language summary
Intervensi pemberian makanan untuk pertumbuhan dan pembentukan bayi dengan bibir terbelah, lelangit terbelah atau bibir dan lelangit terbelah.
Bibir terbelah dan lelangit terbelah(bumbung mulut) adalah kecacatan yang lazim. Keterukan belahan(pembukaan) adalah berbeza‐beza dan ia boleh terjadi sebelah (ekasisi) atau kedua‐dua belah (dwisisi). Keadaan ini menyukarkan pemberian makanan bernutrisi kepada bayi, dan terdapat bukti pembentukan lewat dalam kalangan kanak‐kanak belahan.
Ulasan ini bertujuan membandingkan keberkesanan pelbagai intervensi pemberian makanan misalnya nasihat dan sokongan ibu, modifikasi botol dan/atau puitng, obturator atau plet maksila (plet yang diletak pada bumbung mulut untuk menutup belahan lelangit) dan penyususan susu ibu tambahan dalam kalangan bayi dengan bibir terbelah atau/dan lelangit sebelum atau selepas penutupan belahan. Hanya intervensi dalam 6 bulan pertama dan penggunaan susu ibu atau susu formula dipertimbangkan, namun hasil (ukuran pertumbuhan, pembentukan dan kepuasan ibubapa) mungkin juga diukur pada bila‐bila masa termasuk pada peringkat dewasa.
Nasihat dan sokongan ibu tentang teknik memberi makan dan posisi penyusuan sering diberi tetapi tiada kajian yang menilai keberkesanan intervensi tersebut. Botol yang boleh dipicit mungkin lebih mudah digunakan berbanding botol keras untuk memberi makanan bayi yang ada belahan bibir dan/atau lelangit, dan penyusuan susu ibu mungkin mempunyai kelebihan pertumbuhan berbanding memberi makanan dengan sudu selepas pembedahan belahan bibir. Hanya lima kajian (melibatkan 292 bayi) membandingkan keberkesanan intervensi dalam kalangan bayi rekahan bibir dan/atau lelangit terhadap pertumbuhan, pembentukan atau kepuasan ibubapa. Bukti tentang penyusuan susu ibu berbanding pemberian makanan dengan sudu selepas surgeri adalah lemah dan terdapat cadangan penggunaan botol boleh picit mungkin lebih senang diguna berbanding botol tegar. Tiada bukti untuk menyokong penggunaan plet maksila dalam kalangan bayi dengan klef ekasisi dan tiada kajian yang menilai keberkesanan nasihat atau sokong ibu. Penyelidikan lanjut diperlukan untuk menilai intervensi yang lebih berkesan bagi mencegah kelewatan pembentukan dalam kalangan bayi dengan rekahan bibir dan/atau lelangit.
