Cochrane · intervention · CD003315
Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate
Bessell, A, Hooper, L, Shaw, WC, et al. · Cochrane Database of Systematic Reviews · 2011 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
14
current version
GRADE rated
0
No studies
1
Included studies
5
as reported
No studies 1 · 7.1%Ungraded 13 · 92.9%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). Babies with Pierre Robin sequence or other syndromes were not included. | Babies with cleft lip only (Darzi 1996), cleft palate or cleft lip and palate prior to closure (Brine 1994, Masarei 2007), clefts of lip/palate/lip and palate (Shaw 1999), or complete unilateral cleft lip and palate (Prahl 2005); age birth to 6 months; 37 to 101 babies per study. |
| Intervention | Modified bottles, cups, spoons, pumps, positions, techniques and/or teats (supplemental to or instead of breastfeeding); obturating plates; maternal advice and support. | Squeezable bottles (n=130); Breastfeeding post cleft-lip surgery (n=40); Passive maxillary plate (2 studies) |
| Comparison | Any other intervention, or unmodified equipment or advice. | Rigid bottles (n=130); Spoon-feeding (n=40); No plate |
| Outcomes | Primary: growth (weight until age 16, growth centiles to age 16, head circumference up to 12 months, length). Secondary: development; parental satisfaction. | Weight (n=5); Length (n=4); Head circumference (n=4); Duration of hospital stay (n=1); Quality of life/parental satisfaction (n=1); Reliability of feeding method/bottle modification (n=1); Energy and protein intake (n=1); Adverse events (n=2); Cost (n=1) |
| Study designs | Randomised controlled trials (RCTs), true or quasi methods of random allocation. | Randomised controlled trials (5 RCTs) |
| Timing | Interventions in the first 6 months from term; outcomes may be measured at any time including adulthood. | Follow-up 7 to 13 months up to 18 months; measurements to 12 to 18 months; breastfeeding weight at 6 weeks post-surgery; maxillary plate measured 2 to 12 months. |
Search date: 2010-10. Databases: Cochrane Oral Health Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID (1950); EMBASE via OVID (1980); PsycINFO via OVID (1950); CINAHL via EBSCO (1980)
Questions and results
Show all 3 versionsSqueezable (modified) feeding bottle vs Rigid feeding bottle
Population: Infants up to 6 months (from term) born with cleft lip, cleft palate or cleft lip and palate (Pierre Robin sequence or other syndromes excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Energy and protein intake 3 to 6 months | Mean energy and protein intakes (Brine 1994): statistically significant difference for protein intake at 3 and 6 months in favour of the squeezable bottle (P < 0.05); possibly confounded by four infants receiving a… | 1 study · 37 participants | Ungraded |
Weight (kg) >6 months | MD -0.15 [-0.53, 0.22] | 2 studies · 130 participants | Ungraded |
Reliability of feeding method (number of times bottle modified) up to 12 months | Number of times a bottle had to be modified by the health visitor: 25/52 (48%) for rigid bottles versus 4/49 (8%) for squeezable bottles (Shaw 1999), P < 0.05 (favours squeezable). Six babies randomised to the rigid… | 1 study · 101 participants | Ungraded |
Length (cm) >6 months | MD 0.21 [-0.72, 1.14] | 2 studies · 130 participants | Ungraded |
Quality of life and parental satisfaction (crying, feeding, sleeping, playing time; 24-hour parental log) up to 12 months | Quality of life and adverse events (crying, feeding, sleeping and playing time, 24-hour parental log; Shaw 1999): no statistically significant differences between bottle types. Parental satisfaction also reported. | 1 study · 101 participants | Ungraded |
Head circumference (cm) >6 months | MD -0.66 [-1.16, -0.17] | 2 studies · 130 participants | Ungraded |
Breastfeeding (post cleft-lip surgery) vs Spoon-feeding
Population: Infants up to 6 months (from term) born with cleft lip, cleft palate or cleft lip and palate (Pierre Robin sequence or other syndromes excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Weight (kg) 6 weeks post-surgery | MD 0.47 [0.20, 0.74] | 1 study · 40 participants | Ungraded |
Duration of hospital stay (days) post-surgery | Duration of hospital stay (days): no statistically significant difference between the two groups (Darzi 1996); no pooled estimate displayed (totals not selected). | 1 study · 40 participants | Ungraded |
Adverse events (wound dehiscence; lip scar hypertrophy) post-surgery | Adverse events: one wound dehiscence and one hypertrophy of the lip scar, both in spoon-fed infants (Darzi 1996). | 1 study · 40 participants | Ungraded |
Cost of hospitalisation post-surgery | Average total cost of hospitalisation: 98 Indian rupees (breastfeeding) versus 156 Indian rupees (spoon-feeding) (Darzi 1996). | 1 study · 40 participants | Ungraded |
Passive maxillary/obturating plate (worn until surgical closure of soft palate) vs No plate
Population: Infants up to 6 months (from term) born with cleft lip, cleft palate or cleft lip and palate (Pierre Robin sequence or other syndromes excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Weight (kg) 12 months (351 to 379 days) | MD 0.10 [-0.53, 0.73] | 2 studies · 50 participants | Ungraded |
Head circumference (cm) 12 months | MD 0.25 [-1.03, 1.53] | 1 study · 32 participants | Ungraded |
Length (cm) 2 to 6 months | MD -1.05 [-2.20, 0.11] | 2 studies · 74 participants | Ungraded |
Maternal advice and support (feeding techniques/breastfeeding positions) vs Usual care (no additional advice/support)
Population: Infants up to 6 months (from term) born with cleft lip, cleft palate or cleft lip and palate (Pierre Robin sequence or other syndromes excluded)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No trials were identified that examined the effect of additional maternal support or advice during breastfeeding (or bottle-feeding); no studies evaluated the effectiveness of this intervention (plain-language summary… | 0 studies | No studies |