FACTORS ASSOCIATED WITH BREASTFEEDING ADHERENCE IN INFANTS WITH OROFACIAL CLEFTS: A SCOPING REVIEW<sup/>

Batista, Nayara Tomazi; Antonio, Camila Trettene; Bom, Gesiane Cristina; Farinha, Francely Tineli; Kostrisch, Lilia Maria Von; Mazzo, Alessandra; Trettene, Armando dos Santos

doi:10.1590/ce.v29i0.95133

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REVIEW • Cogitare Enferm. 29 • 2024 • https://doi.org/10.1590/ce.v29i0.95133 copy

FACTORS ASSOCIATED WITH BREASTFEEDING ADHERENCE IN INFANTS WITH OROFACIAL CLEFTS: A SCOPING REVIEW^* * Artigo extraído da dissertação do mestrado: “ALEITAMENTO MATERNO EM CRIANçAS COM FISSURA OROFACIAL: CONSTRUçãO E VALIDAçãO DE UM WEBSITE”, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil, 2023.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To map the factors associated with breastfeeding adherence in infants with orofacial clefts.

Method:

Scoping review according to the recommendations of the Joanna Briggs Institute, with a search carried out in March 2023 in the PubMed, CINAHL, Web of Science, SCOPUS, EMBASE, LILACS, ProQuest and BDTD databases.

Results:

A total of 31 documents were selected. Factors associated with adherence to breastfeeding included: anatomical complexity of the cleft, preand post-natal guidance/training, desire to breastfeed, previous experience, knowledge of the benefits of breastfeeding, use of palatal obturators, use of feeding tube, social, family, and professional support, milking and offering by utensils and early performance of cheiloplasty.

Conclusion:

Although the complexity of the cleft is a factor that cannot be changed early on, the other variables that influence adherence to breastfeeding can be intervened upon. Thus, the support of all those involved in the breastfeeding process is fundamental for its optimization.

KEYWORDS:
Breastfeeding; Cleft palate; Cleft lip; Infants; Review.

HIGHLIGHTS

1. The anatomical complexity of the cleft influences breastfeeding.

2. The absence of negative intraoral pressure is the main limiting factor.

3. Most of the limiting factors are amenable to intervention.

Identification	Publication year and country	Sample	Factors related to breastfeeding adherence
ID¹⁸18 Thomé S. Estudo da prática do aleitamento materno em crianças portadoras de malformações congênita de lábio e/ou de palato [Thesis]. Ribeirão Preto: Universidade de São Paulo, Escola de Enfermagem; 1990. 245 p. [cited 2023 Aug. 18]. Available from: https://repositorio.usp.br/item/000733696 https://repositorio.usp.br/item/00073369...	1990, Brazil.	105 mothers of infants with cleft lip and/or palate, aged between zero and 18 months old.	Anatomical complexity of the cleft, guidance and encouragement from professionals, family, and social support.
ID¹⁹19 Trenouth MJ, Campbell AN. Questionnaire evaluation of feeding methods for cleft lip and palate neonates. Int J Paediatr Dent. [Internet]. 1996 [cited 2023 Aug. 18]; 6(4):241-4. Available from: https://doi.org/10.1111/j.1365-263x.1996.tb00252.x https://doi.org/10.1111/j.1365-263x.1996...	1996, England.	25 mothers of neonates with cleft lip and/or palate	Guidance provided by trained professionals during hospitalization and support after discharge.
ID²⁰20 Kogo M, Okada G, Ishii S, Shikata M, Iida S, Matsuya T. Breast feeding for cleft lip and palate patients, using the Hotz-type plate. Cleft Palate Craniofac J. [Internet]. 1997 [cited 2023 Aug. 18]; 34(4):351-3. Available from: https://doi.org/10.1597/1545-1569_1997_034_0350_bffcla_2.3.co_2 https://doi.org/10.1597/1545-1569_1997_0...	1997, Japan.	10 infants with cleft lip and palate.	Use of a palatal obturator.
ID²¹21 Araruna R da C, Vendrúscolo DMS. Alimentation of children with lip-palate malformation: a bibliographic study. Rev Latino-Am Enfermagem. [Internet]. 2000 [cited 2023 Aug. 18]; 8(2):99-105. Available from: https://doi.org/10.1590/S0104-11692000000200015 https://doi.org/10.1590/S0104-1169200000...	2000, Brazil.	Not reported.	Complexity of the cleft, health education and the mother’s desire to breastfeed.
ID²²22 Turner L, Jacobsen C, Humenczuk M, Singhal VK, Moore D, Bell H. The effects of lactation education and a prosthetic obturator appliance on feeding efficiency in infants with cleft lip and palate. Cleft Palate Craniofac J. [Internet]. 2001 [cited 2023 Aug. 18]; 38(5):519-24. Available from: https://doi.org/10.1597/1545-1569_2001_038_0519_teolea_2.0.co_2 https://doi.org/10.1597/1545-1569_2001_0...	2001, Brazil.	Eight infants with cleft lip and palate.	The use of a palatine obturator associated with health education.
ID²³23 Dalbem GS, Costa B, Gomide MR, Neves LT. Breast-feeding and sugar intake in babies with cleft lip and palate. Cleft Palate Craniofac J. [Internet]. 2003 [cited 2023 Aug. 18]; 40(1):84-7. Available from: https://doi.org/10.1597/1545-1569_2003_040_0084_bfasii_2.0.co_2. https://doi.org/10.1597/1545-1569_2003_0...	2003, Brazil.	200 infants with cleft lip and/or palate.	Anatomical complexity of the cleft.
ID²⁴24 Reid J. A review of feeding interventions for infants with cleft palate. Cleft Palate Craniofac J. [Internet]. 2004 [cited 2023 Aug. 18]; 41(3):268-78. Available from: https://doi.org/10.1597/02-148.1 https://doi.org/10.1597/02-148.1...	2004, Australia.	55 articles.	Use of a palatine obturator, preand post-natal guidance, and adaptive positions.
ID²⁵25 Garcez LW. Estudo de base populacional sobre a prática do aleitamento materno em crianças nascidas com fissura labiopalatina na cidade de Porto Alegre [Dissertation]. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2004. 74 p. [cited 2023 Aug. 18]. Available from: http://hdl.handle.net/10183/5132 http://hdl.handle.net/10183/5132...	2004, Brazil.	31 infants with cleft lip, lip and palate, and palate.	Anatomical complexity of the cleft, preand post-natal guidance by qualified professionals.
ID²⁶26 Rocha CMG, Dias MCM, Pereira LCB, Melo M do CB de, Lamounier JA. Breastfeeding and cleft lip and/or palate: review and update. Rev Med Minas Gerais. [Internet]. 2008 [cited 2023 Aug. 18]; 18(4):77-82. Available from: https://rmmg.org/artigo/detalhes/1404 https://rmmg.org/artigo/detalhes/1404...	2008, Brazil.	39 documents.	Anatomical complexity of the cleft.
ID²⁷27 Campillay PL, Delgado SE, Brescovici SM. Evaluation of feeding in children with cleft lip and/or palate assisted in a hospital of Porto Alegre. Rev. CEFAC. [Internet]. 2010 [cited 2023 Aug. 18]; 12(2):257-66. Available from: https://doi.org/10.1590/S1516-18462010005000010 https://doi.org/10.1590/S1516-1846201000...	2010, Brazil.	23 children with cleft lip, palate and/or lip and palate.	Anatomical complexity of the cleft.
ID²⁸28 Pathumwiwatana P, Tongsukho S, Naratippakorn T, Pradubwong S, Chusilp K. The promotion of exclusive breastfeeding in infants with complete cleft lip and palate during the first 6 months after childbirth at Srinagarind Hospital, Khon Kaen Province. J Med Assoc Thai. [Internet]. 2010 [cited 2023 Aug. 18]; 93(4):71-7. Available from: https://pubmed.ncbi.nlm.nih.gov/21302391/ https://pubmed.ncbi.nlm.nih.gov/21302391...	2010, Thailand.	20 infants with cleft lip and palate.	Preand post-natal counseling by qualified professionals and family support.
ID²⁹29 Di Ninno CQ, Moura D, Raciff R, Machado SV, Rocha CMG, Norton RC, et al. Exclusive breastfeeding in infants with cleft lip and/or palate. Rev Soc Bras Fonoaudiol. [Internet]. 2011 [cited 2023 Aug. 18]; 16(4): 417-21. Available from: https://doi.org/10.1590/S1516-80342011000400009 https://doi.org/10.1590/S1516-8034201100...	2011, Brazil.	137 children with cleft lip and/or palate.	Anatomical complexity of the cleft.
ID³⁰30 Mendes LGA. Aspectos da atenção à saúde a indivíduos com fenda de lábio e(ou) palato no brasil e propostas para seu incremento no SUS [Thesis]. Campinas (SP): Universidade de Campinas; 2011. 196 p. [cited 2023 Aug. 18]. Available from: https://doi.org/10.47749/T/UNICAMP.2011.789387 https://doi.org/10.47749/T/UNICAMP.2011....	2011, Brazil.	215 parents of children with cleft lip and/or palate, from eight institutions.	Anatomical complexity of the cleft.
ID³¹31 Dubey A, Mujoo S, Khandelwal V, Nayak PA. Simplified design and precautionary measures in fabrication of a feeding obturator for a newborn with cleft lip and palate. BMJ Case Rep. [Internet]. 2013 [cited 2023 Aug. 18]; 16:bcr2013010465. Available from: https://doi.org/10.1136/bcr-2013-010465 https://doi.org/10.1136/bcr-2013-010465...	2013, India.	Newborn with cleft lip and palate.	Use of a palatal obturator.
ID¹¹11 Lindberg N, Berglund AL. Mothers’ experiences of feeding babies born with cleft lip and palate. Scand J Caring Sci. [Internet]. 2014 [cited 2023 Aug. 18]; 28(1):66-73. Available from: https://doi.org/10.1111/scs.12048 https://doi.org/10.1111/scs.12048...	2014, Norway.	Nine mothers of infants with cleft lip.	Guidance by trained health professionals.
ID³²32 Mzezewa S, Hamese K, Mashego TAB. Neonatal cleft lip repair in babies with breastfeeding difficulties at Polokwane Mankweng Hospital Complex. S. Afr. j. child health. [Internet]. 2014 [cited 2023 Aug. 18]; 8(4):157-9. Available from: http://dx.doi.org/10.7196/SAJCH.693 http://dx.doi.org/10.7196/SAJCH.693...	2014, South Africa.	23 newborns with cleft lip, lip, and palate.	Early performance of cheiloplasty.
ID³³33 Alperovich M, Frey JD, Shetye PR, Grayson BH, Vyas RM. Breast milk feeding rates in patients with cleft lip and palate at north american craniofacial center. Cleft Palate Craniofac J. [Internet]. 2017 [cited 2023 Aug. 18]; 54(3):334-7. Available from: https://doi.org/10.1597/15-241 https://doi.org/10.1597/15-241...	2017, United States.	110 infants with isolated cleft lip or lip and palate.	The desire to breastfeed, preand post-natal guidance and professional support.
ID³⁴34 Burianova I, Kulihova K, Vitkova V, Janota J. Breastfeeding after early repair of cleft lip in newborns with cleft lip or cleft lip and palate in a baby-friedly designated hospital. J Hum Lact. [Internet]. 2017 [cited 2023 Aug. 18]; 33(5):504-8. Available from: https://doi.org/10.1177/0890334417706062 https://doi.org/10.1177/0890334417706062...	2017, Czech Republic.	104 newborns with isolated cleft lip or lip and palate.	Professional support and early cheiloplasty.
ID³⁵35 Luiz GA. Alimentação do lactente com fissura labiopalatina no primeiro ano de vida [Dissertation]. Botucatu (SP): Universidade Estadual Paulista; 2017. 83 p. [cited 2023 Aug. 18]. Available from: http://hdl.handle.net/11449/150423 http://hdl.handle.net/11449/150423...	2017, Brazil.	150 mothers of children with cleft lip and/or palate.	Guidance received during the prenatal period.
ID⁶6 Trettene A dos S, Maximiano T de O, Beraldo CC, Mendonça JSC, Luiz AG, Costa B. Breastfeeding in infants with labiopalatine cleft. Rev enferm UFPE Online. [Internet]. 2018 [cited 2023 Aug. 18]; 12(5):1390-6. Available from: https://doi.org/10.5205/1981-8963-v12i5a230983p1390-1396-2018 https://doi.org/10.5205/1981-8963-v12i5a...	2018, Brazil.	121 caregivers of children with isolated cleft lip, lip and palate and palate.	Cleft complexity and the information received by health professionals during prenatal care.
ID³⁶36 Murthy PS, Desmukh S, Murthy S. Assisted breastfeeding technique to improve knowledge, attitude, and practices of mothers with cleft lipand palate-affected infants: a randomized trial. Spec Care Dentist. [Internet]. 2020 [cited 2023 Aug. 18]; 40:273-9. Available from: https://doi.org/10.1111/scd.12464 https://doi.org/10.1111/scd.12464...	2020, India.	32 informal caregivers of infants with unilateral or bilateral isolated cleft lip and palate, aged between zero and six months.	Orientation/training through audiovisual education modules.
ID³⁷37 Madhoun LL, Crerand CE, Keim S, Baylis AL. Breast milk feeding practices and barriers and supports experienced by mother-infant dyads with cleft lip and/or palate. Cleft Palate Craniofac J. [Internet]. 2020 [cited 2023 Aug. 18]; 57(4):477-86. Available from: https://doi.org/10.1177/1055665619878972 https://doi.org/10.1177/1055665619878972...	2020, United States.	150 biological mothers of infants aged between eight and 14 months who had an isolated unilateral or bilateral cleft lip and palate.	Anatomical complexity of the cleft, prenatal guidance/training, and supply of milked milk.
ID³⁸38 Adekunle AA, Adamson O, James O, Ogunlewe OM, Butali A, Adeyemo WL. Breastfeeding practices among mothers of children with orofacial clefts in an african cohort. Cleft Palate Craniofac J. [Internet]. 2020 [cited 2023 Aug. 18]; 57(8):1018-23. Available from: https://doi.org/10.1177/1055665620919312 https://doi.org/10.1177/1055665620919312...	2020, Nigeria.	65 mothers of infants with isolated cleft lip or lip and palate, aged between one and 16 months.	Anatomical complexity of the cleft, preand post-natal orientation/training.
ID³⁹39 Jara MG, Inostroza-Allende F, Norambuena SN, Farías JC. Breastfeeding and factors associated to feeding in babies with cleft palate. Int J Med Sci. [Internet]. 2020 [cited 2023 Aug. 18]; 7(4):1-10. Available from: https://doi.org/10.32457/ijmss.v7i4.587 https://doi.org/10.32457/ijmss.v7i4.587...	2020, Chile.	36 infants with isolated cleft palate, aged between zero and six months.	Knowledge of breastfeeding benefits, use of feeding tubes, breast milk milking and professional support.
ID⁴⁰40 Gárate KMS, Martins ML, Castro GFB de A, Costa B. Types of feeding and presence of harmful oral habits in children with cleft lip and/or palate: a pilot study. Pesqui Bras Odontopediatria Clín Integr. [Internet]. 2020 [cited 2023 Aug. 18]; 20:e0063. Available from: https://doi.org/10.1590/pboci.2020.154 https://doi.org/10.1590/pboci.2020.154...	2020, Brazil.	162 caregivers of children with cleft lip; lip and palate; and isolated palate.	Anatomical complexity of the cleft.
ID⁴¹41 Miranda-Filho AEF, Gomes HS, Silva RBV, Marques NP, Martelli Junior H, Marques NCT. Do orofacial clefts impair breastfeeding and increase the prevalence of anemia? Cleft Palate Craniofac J. [Internet]. 2021 [cited 2023 Aug. 18]; 60(1):63-8. Available from: https://doi.org/10.1177/10556656211054331 https://doi.org/10.1177/1055665621105433...	2021, Brazil.	210 children with isolated cleft lip; lip and palate; or palate.	Anatomical complexity of the cleft.
ID⁴²42 Nabatanzi M, Seruwagi GK, Tushemerirwe FB, Atuyambe L, Lubogo D. “Mine did not breastfeed”, mothers’ experiences in breastfeeding children aged 0 to 24 months with oral clefts in Uganda. BMC Pregnancy Childbirth. [Internet]. 2021 [cited 2023 Aug. 18]; 21(100):1-9. Available from: https://doi.org/10.1186/s12884-021-03581-3 https://doi.org/10.1186/s12884-021-03581...	2021, South Africa.	32 children with cleft lip, lip and palate or palate in isolation, aged between zero and 24 months.	Anatomical complexity of the cleft, milking and supply using utensils, family, and social support.
ID⁴³43 Lopez-Bassols I. Assisted Nursing: a case study of an infant with a complete unilateral cleft lip and palate. J Hum Lact. [Internet]. 2021 [cited 2023 Aug. 18]; 37(2):419-24. Available from: https://doi.org/10.1177/0890334420964159 https://doi.org/10.1177/0890334420964159...	2021, United Kingdom.	A child with an isolated unilateral cleft lip and palate, monitored from birth to 11 months.	The desire to breastfeed, previous experience of breastfeeding, social and professional support.
ID⁴⁴44 Achmad H, Samad R, Nasir M, Djais AI, Lesmana H, Sitanaya R. Nutritional improvement in children with cieft llp and cleft palate using a combination of an obturator and feeding bottle infant. J. Pharm. Negat. [Internet]. 2022 [cited 2023 Aug. 18]; 1(1). Available from: http://repository.unhas.ac.id/id/eprint/23434/ http://repository.unhas.ac.id/id/eprint/...	2022, Indonesia.	11 articles.	Use of a palatine obturator and baby bottles.
ID⁴⁵45 Cerón-Zapata AM, Martínez-Delgado CM, Calderón-Higuita GE. Maternal perception of breastfeeding in children with unilateral cleft lip and palate: a qualitative interpretative analysis. Int. Breastfeed. J. [Internet]. 2022 [cited 2023 Aug. 18]; 54:571-81. Available from: https://doi.org/10.1016/S0140-6736(09)60695-4 https://doi.org/10.1016/S0140-6736(09)60...	2022, Colombia.	28 mothers of children with unilateral, non-syndromic cleft lip and/or palate.	The mother’s desire to breastfeed.
ID¹⁰10 Oliveira LB de, Fonseca-Souza G, Rolim TZ, Scariot R, Feltrin-Souza J. Breastfeeding and cleft lip and palate: a systematic review and meta-analysis. Cleft Palate Craniofac J. [Internet]. 2023 [cited 2023 Aug. 18]; 20:10556656231170137. Available from: https://doi.org/10.1177/10556656231170137 https://doi.org/10.1177/1055665623117013...	2023, Brazil.	29 studies.	Anatomical complexity of the cleft.

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[1] Associate editor: Dra. Tatiane Trigueiro