Introduction
The Egyptian Dental Journal published a research titled “Cleft LipandPalate Nutritional Assessment And Feeding Challenges”. This study was published in October, 2019 by the author whose name is Hatitham Attia. The author introduced Cleft Lip and/or Palate (CLP) as most occurring craniofacial anomalies and it might be syndromic or non-syndromic, or associated with various systems affection as cardiovascular, pulmonary, and auditory. He explained that after birth, feeding comes first with difficulties of sucking and swallowing because of lack of intraoral negative pressure and nipple seal. He added that parents of infants suffering from CLP have questions and doubts regarding feeding challenges such as how they can manage the feeding and if they need support and help from a professional caregiver. He mentioned some ways that parents and caregiver use to provide infants with nutrition for proper development, which are breast feeding and spoon feeding. The author highlighted very important piece of information to support the importance of his study by stating that “there is a lack of data regarding studies focusing on feeding problems and approaches to be developed to compensate for such difficulty with (CLP) infants”.
Therefore, this study aimed to evaluate the care practices associated with infants with CLP in multicentre, highlight the feeding challenges of these infants that parents and caregivers experience and analysis the alternative feeding interventions they perform in the preoperative period based on their experiences. Also, to compare the rate of alternative feeding interventions and Intensive Care Unit (ICU) admissions among different cleft types. Finally, to compare patients who had used obturators and the ones who had not used them in relation to feeding difficulties to detect the role of the obturators.To conduct this study, the author sent a questionnaire to 100 parents of infants with CLP who were born in Egypt and Saudi Arabia and had surgical correction between July 1st, 2017 and August 15th, 2018. Cleft lip surgeries were performed approximately at 45 days of age, and cleft palate closure around 9 months of age. Hence, Syndromic CLP cases were not included in this study. Before distributing the questionnaire among parents, an assessment was administered to evaluate doubts that parents might have in their responses.
This assessment was through completing questionnaire by 10 parents who are not contributing in this study. Each parent signed a consent form to ensure an agreement to involve them in the research. Additionally, this study was approved by ethic committee in each centre involved. The questionnaire of the study was developed based on feeding difficulties and challenges that had been faced by caregivers and parents. Therefore, based on the researcher’s clinical experience those challenges were translated into the questionnaire. Parents completed the questionnaire through their routinely post-operatively follow up visits in one week, 4 weeks, 3 months, 6 months and one year. The author listed the results of his study under four sections; prenatal and postnatal period, breastfeeding, feeding challenges and intervention challenges. It is very organized method to deliver the information to the reader clearly.
prenatal and postnatal period
- Prenatal diagnosis was 37% of the affected cases.
- 91.9% of 37% indicated that they investigated the feeding methods before the birth of their infants through education provided by internet, oral and maxillofacial surgeons, pediatricians, other parents with cleft infants, gynaecologist, and orthodontists.
- 46% of 37% stated that they had good education and their infants stayed the intensive care unit (ICU) for an average 3.7 days in comparison to 7.4 days compared with parents who didn’t receive education during pregnancy.
- No difference regarding rate of admission to the intensive care unit between two groups.
- 54% of the affected infants were admitted to the ICU following birth; 5 cases isolated cleft lip, 15 cases isolated cleft palate, and 34 cases cleft lip and palate.
Breastfeeding
- Only 12.2% of parents could breastfeed their infants.
- cleft palate is the lowest rate in breastfeeding despite the presence or absence of cleft lip.
- 37% of parents used the caregiver service to help in breastfeeding.
- Ten caregivers were instructed by the intensive care unit physician not to breastfeed.
Feeding challenges
86.7% of isolated cleft lip infants showed no feeding difficulties.
Feeding interventions
- 40% of infants had Nasogastric or orogastric tube feeding.
- The number of infants needed nasogastric tube increased when the palate is involved.
- Higher ratio of nasogastric feeding was showed in cases affected by both cleft lip and palate.
- 64% of infants were feed using syringes.
- 35% required palatal obturators out of 77 infants with cleft palate.
- High ratio of obturators usage 67% in infants with both cleft lip and palate and less percentage 33% in isolated cleft palate patients.
- 58% parents stated that pacifiers were very helpful.
Article Critique
The article under review is quite effective, although some limitations should also be mentioned. As far as the strengths of the article in question are concerned, it includes a detailed description of results that are properly presented. Attia (2019) describes the methods used to obtain data, and the results are also presented effectively. The author uses tables with the appropriate descriptions, so the reader can follow the researcher and the major arguments. The sample size is quite small but is still appropriate for research that addresses a specific group’s perspectives. The data collection and analysis methods are also valid and reliable, so the findings are valid and reliable as well. The researcher also refers to reliable academic resources (mainly scholarly articles) to support claims.
At the same time, the majority of the utilized resources are rather outdated as they were published in the 2010s or earlier. Attia (2019) also fails to highlight the limitations of the study and areas of further exploration. The conclusion part is quite short and could be enhanced by the inclusion of such aspects as limitations, further research, as well as clinical and other implication.
Conclusion
To sum up, it is possible to note that the article under analysis is quite effective as the researcher sets clear goals, utilizes valid methodology, and describes the results in detail. However, the article could be improved by the use of more recent sources and the inclusion of such aspects as limitations of the study, areas of further study, and implications. At that, the article is informative and easy to follow, and it contributes to the current knowledge base on the feeding challenges of the parents of children with cleft lip and/or palate face.
Reference
Attia, H. (2019). Cleft lip and palate nutritional assessment and feeding challenges. Egyptian Dental Journal, 66(1), 3357–3364.