Feeding baby after cleft lip repair

Dehiscence is rare

But is this precaution really necessary? To find out, researchers in Japan reviewed studies published in English and Japanese - reaching all the way back to 1950. They were curious to discover if breastfeeding or bottle feeding had any effect on the surgical incision. After all, feeding in a normal way would appear to be the best way for the baby to recover, and stay on course with weight gain and growth.

Of the 342 babies included in the studies, only 2 had experienced dehiscence - 1 due to an accidental fall. The reason for the other case of partial dehiscence was not noted. Other than these 2 incidents, the researchers did not find any cases whatsoever of dehiscence when babies immediately returned to breast or bottle feeding following surgery.

Dehiscence was found to be so rare that whenever it occurs, the researchers recommended that it should be immediately reported and investigated as a sentinel event, to rule out negligence or medical mistakes.

Significant weight gain

Following their cleft lip repair surgery, the babies who were breastfed immediately following their operation gained significantly more weight by 6 weeks than spoon-fed babies. By 1 month post-operative, the breastfed babies had gained 28% of their preoperative weight, on average. And by 3 months, the weight gain was up to 67%.

Compare this with the group of infants fed with cups or syringes. They only gained 17% on average by 1 month post-operative, and 43% after 3 months. Aside from weight gain, alternative means of feeding were also found to cause babies distress - which can make babies cry, placing stress on the healing incision. And stress is precisely what these babies need to avoid to prevent dehiscence.

Elbow restraints

The researchers also looked at forms of elbow restraint following cleft lip repair, which have been used in hospitals to prevent the baby from touching or damaging the incision. In randomized studies, no differences were found between those babies restrained and those who were not - which calls into question the need for such restraints.

The researchers also questioned whether restraints may actually cause more problems, by increasing the risk of accidents or incidents of baby crying – both of which places tension on the stitches in baby’s lip . In fact, the benefits of immediate breast or bottle feeding were so clear, the researchers recommended against any further control group studies as unethical. 

Keeping baby happy

Following cleft lip surgery, studies show that babies can also safely use suck on their thumb, fingers or a soother to calm themselves. In addition, the babies did not experience any other issues with their surgical incision, such as swelling, bleeding or infection. That's great news for babies, their parents and those who provide care for them.

Keeping baby calm and happy appears to be the best advice. It's important to prevent babies from crying so they do not stress the incision. Quickly returning to the baby's normal way of eating lessens levels of discomfort, while allowing the baby to continue taking in enough nutrition to keep on gaining weight and growing. And as all midwives and other healthcare professionals well know, nutrition and comfort is key to healing.

References
Matsunaka E, Ueki S, Makimoto K. Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol. JBI Database System Rev Implement Rep. 2015 Oct;13(10):3-11.