The standard of care provided in our center in the preoperative period of the babies with cleft lip and/or palate
Based on our clinical experiences, we listed the standards of care provided in our center as practical implications in cleftcare, feeding management, and nursing care.
After the detection of cleft lip and/or palate (CLP) in the intrauterine period, a standard of referral of families to a professional cleft team is necessary.
An experienced cleft team should take part in this formidable period of families beginning with the prenatal diagnosis and play a key role in terms of parental education on cleftcare and initial assessment of infant’s feeding skills rather than giving their support just for the operative period.
Breastfeeding is of significant importance in all types of clefts. It is well known that infants with isolated cleft lip have higher success rates in breastfeeding. However, caregivers of infants with cleft palate are also encouraged for breastfeeding/latching to strengthen maternal-infant bonding and to support psychosocial development of the infant. Mothers having difficulties in breastfeeding are informed to express and store their breast milk to feed their baby.
Psychologic enteral feeding should be maintained in infants with CLP. Unless there are Pierre-Robin sequence, swallowing dysfunction, hypotonia, severe syndromic comorbidities, placement of an orogastric or a nasogastric tube, which aggravates the clinical symptoms, is not recommended to preserve the suck and swallow reflex which is vital in nutrition of these infants. Placement of an orogastric or a nasogastric tube is justifiable only if the infant has hypoglycemia in 48 hours after birth which is similar to the treatment provided to unaffected newborns.
Intensive care unite stay is unnecessary unless there are accompanying disorders.
Spoon-feeding and feeding with commercially available specialized bottles are encouraged in infants with CLP rather than feeding with syringes due to its hard to control nature by caregivers.
We do not recommend the use of obturators to improve feeding of infants with CLP. The only implementation of that type of materials in our clinical practice is the nasoalveolar molding which is solely recommended for some selected bilateral cleft lip patients with a protruding premaxilla.
We encourage parents to use pacifiers in infants with cleft to strengthen their sucking efficiency and to stimulate mandibular advancement.
