Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol

Abstract

Immediately after cleft lip repair in infants, breastfeeding and bottle-feeding are generally restricted. Alternative feeding methods such as spoon-feeding are recommended to avoid placing tension on the surgical wound. However, some studies have reported that alternative feeding methods are a source of stress to the infant and cause them to cry incessantly, resulting in postoperative weight loss. This suggests that these alternative feeding methods may have an unfavorable impact on surgical wound healing. However, a consensus on this topic has not been reached. The objective of this systematic review is to examine the impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants.Cleft lip and/or palate is a craniofacial anomaly and one of the most common birth defects. The incidence of cleft lip and/or palate differs among races, ethnic groups and geographical areas. The prevalence of cleft lip and/or palate is highest in South American countries (Bolivia: 22.94 per 10,000 live births; Paraguay: 14.90 per 10,000 live births), followed by Asian countries (China: 13.60 per 10,000 live births; Japan: 16.04 per 10,000 live births). The prevalence is lowest in African countries (3.54 per 10,000 live births). The overall worldwide prevalence is 7.9 per 10,000 births.A cleft lip and/or a cleft palate can occur separately, although they are more likely to occur together early in pregnancy. These anomalies can be surgically repaired. Without proper treatment, patients have aesthetic and functional problems, such as feeding disorders, otitis media and speech difficulties.Patients with cleft lip and/or palate usually undergo a combination of surgical procedures, speech therapy and orthodontic treatment from infancy to young adulthood. Comprehensive treatment is provided with thoughtful consideration of the balance between intervention and growth. Cleft lip repair is carried out first in comprehensive treatment regimens. The aim of cleft lip repair is to create contrast between the lip and external nose and provide good muscular continuity across the cleft without any scarring. It is usually performed from three to six months of age. Surgery is delayed until this age to allow for growth of the lip structure and assessment of the patient for the presence of comorbidities. The ability of newborn patients with cleft lip and/or palate to drink milk is important for proper growth and development.For cleft lip and/or palate patients in the newborn developmental stage, feeding can be an area of great concern and anxiety for their parents. One study found that 32% of newborn patients with cleft lip and/or palate had poor feeding skills. Feeding difficulties lead to poor growth and development in early infancy and increase the burden of care. Therefore, it is important for new parents to learn appropriate feeding techniques. Infants with cleft lip can generally drink milk from the breast through various ways of feeding. In contrast, infants with both cleft lip and palate have difficulty suc...

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

“…Gbolahan et al52 investigated the utility of wound coverings after cleft lip repair and found no difference between intervention and control groups in terms of wound infection, dehiscence, and scar appearance. Matsunaka et al54 found there to be no increase in wound dehiscence in infants that breast and/or bottle fed after cleft lip repair compared with those who underwent alternative feeding approaches such as syringe feeds.…”

“…Four studies investigated the topic of cleft lip closure and dehiscence (Supplemental Table 8, Supplemental Digital Content 8, http://links.lww.com/SCS/E645). 6,[52][53][54] Two of the studies focused mainly on wound closure. 6,53 Of these studies, 1 compared the use of absorbable sutures to nonabsorbable sutures and tissue adhesive in cleft lip repair.…”

Current trends in unilateral cleft lip repair

“…This is largely done out of historical practice and is not based on objective data. Matsunaka et al [28] as well as numerous other studies have proven no increased risk of wound complication or dehiscence from the perioral mechanics of early postoperative breast/bottle feeding.…”

“…In general, in the immediate postoperative period breast and bottle-feeding is restricted to avoid placing tension on the surgical incision, with many centers advocating for a 3–30 day ‘bottle holiday.’ This is largely done out of historical practice and is not based on objective data. Matsunaka et al [28] as well as numerous other studies have proven no increased risk of wound complication or dehiscence from the perioral mechanics of early postoperative breast/bottle feeding.…”

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

“…Negative consequences may include prolonged feeding times, nasal regurgitation, reflux, and insufficient milk transfer (Kaye et al, 2017). Newborns with large clefts need special feeding methods, nutritional follow-up focusing on adequate weight gain, and prevention of dehydration (Cohen et al, 1992; Matsunaka et al, 2015; Gailey, 2016). There is no systematic review covering orofacial clefts and breastfeeding rates, and there is limited literature describing early cheiloplasty and breastfeeding outcome (Cohen et al, 1992; Harris et al, 2010; Gailey, 2016).…”