Assisted feeding is more reliable for infants with clefts--a randomized trial. Effectiveness of two feeding methods in improving energy intake and growth of infants with cleft palate: a randomized study. The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants. Infant orthopedics in UCLP: effect on feeding, weight, and length: a randomized clinical trial (Dutchcleft). Breast feeding or spoon feeding after cleft lip repair: a prospective, randomised study.
To compare the effectiveness of squeezable and rigid feeding bottles for infants with clefts.
                Patients were randomly assigned at birth to feeding with a squeezable bottle (assisted feeding) or to feeding with a rigid bottle and were followed for 1 year. The data were analyzed on the basis of intention to treat.
                The trial was conducted within the existing arrangements for hospital and home care for children with clefts within the National Health Service in the north of England.
                The patients were 101 consecutively born children with cleft lip and/or palate who were otherwise healthy. All patients completed the trial. Two were excluded from the analysis when unrelated developmental problems became apparent.
                Anthropometric measures-nude weight, crown-heel length (CHL), and occipito-frontal circumference (OFC)-were recorded.
                There were statistically significant differences between the two groups in weight at 12 months (p = .038, with an adjusted mean difference of 0.43 kg) and in head circumference (p = .004 with an adjusted mean difference of 0.77 cm), indicating increased growth in the squeezable bottle group. The difference in CHL was not significant at conventional levels (p = .082). Whereas 25 of 52 (48%) rigid bottles required modification by the health visitor, this was needed for only 4 of 49 (8%) squeezable bottles. There was a highly significant difference when numbers of modifications for each method were compared (p < .0001). Despite modifications, six infants feeding with a rigid bottle (11%) were transferred to a squeezable bottle due to problems with feeding, but none were transferred from squeezable to rigid bottles. Thus, the squeezable bottle generally appeared to be a more satisfactory method, requiring less support or intervention after initial instruction.
                Both feeding methods achieved similar anthropometric outcomes, with a beneficial effect on head circumference and weight in the assisted feeding group. We recommend that this last observation be treated with caution. The squeezable bottles were easier to use, and we recommend that they be routinely prescribed. To compare two feeding methods advocated for infants with cleft palate: (a) a squeezable plastic container with a narrow, long crosscut nipple (squeezable cleft palate nurser); and (b) a standard nipple with a crosscut (crosscut nipple). The effectiveness of a nutrition intervention protocol for these infants was also documented.
                Thirty-one infants (median age = 15 days) were randomized to one of two feeding methods (18 infants, squeezable cleft lip/palate nurser; 13 infants, crosscut nipple) within sex (21 boys, 10 girls) and palatal defect (22 cleft lip and palate, 9 isolated cleft palate) categories. The intervention included feeding technique instructions, nutrition counseling at each clinic visit, use of the same 20 kcal/oz standard formula for 12 months, and introduction of infant and soft table foods at 6 months. Four-day food records and growth data were obtained.
                Mean energy and protein intakes at 3 and 6 months of age and growth measurements during the first 18 months of life were obtained.
                A repeated measures analysis of variance for intakes was performed with time as the repeated measure and feeding method as the covariable. Similar analyses were completed for growth measures with sex and feeding method as covariates.
                Mean energy intake at 3 and 6 months of age (P = .24) and growth measurements during the first 18 months of life (P values: weight gain [grams per day], .73; weight, .21; length, .07; head circumference, .18; triceps and subscapular skinfolds and mid-arm circumference, .47, .48, and .69, respectively) were not significantly different. Both feeding methods were effective in supporting normal growth.
                With adequate instruction related to the use of either feeding technique and close nutrition follow-up early in infancy, a dietitian or other health care practitioner may advise the use of either feeding method. These data support the need for feeding and nutrition education and early nutrition intervention. Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age.
                North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics.
                Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate.
                Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003).
                Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005).
                This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers. To study the effects of infant orthopedics (IO) on feeding, weight, and length.
                Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method.
                Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands.
                Infants with complete unilateral cleft lip and palate (UCLP), no other malformations.
                One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO-) did not. All other interventions were the same for both groups.
                Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands' third nationwide survey on growth.
                Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO- group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure.
                Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned. It has been a tradition for plastic surgeons to withhold breast feeding from babies after cleft lip repair to prevent wound disruption. A prospective, randomised trial of 40 infants showed that early postoperative breast feeding after cleft lip repair is safe, results in more weight gain at 6 weeks after surgery (P < 0.01) and is more economical than spoon feeding.
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.