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Ranjidam Kent and Vanessa Martin compare the experiences and management of children fed nasogastriclly for up to 24 hours to determine post-operative outcomes
Summary
Almost 1,000 babies are born each year with some form of cleft, whether it is a palate, lip or a combination. However, with the advent of new regional cleft centres and specialist professionals caring for larger numbers of children with a cleft lip and palate, the long-term outcomes of these patients should show improvement. The nursing care on paediatric wards will make an important contribution to these outcomes. In this article, post-operative feeding, analgesia and inpatient stays following cleft palate repair are examined. In a post-palatoplasty study of 68 babies, 34 who were fed orally and 34 nasogastrically, the babies who were fed nasogastrically were more settled, needed less analgesia and were discharged earlier. The parents of these babies were more relaxed knowing their child was fed and had adequate analgesia, and nurses believed they were able to give these babies a better quality of care.
Keywords
Cleft palate, congenital abnormalities, infants: disorders
IN 1998, the Clinical Standards Advisory Group (CSAG), set up to advise health ministers on this topic, recommended that there should be multidisciplinary care of all children with a cleft lip and palate, and that this care should be confined to a few regional centres. About one in 726 babies are born annually with a cleft lip and/or palate (CRANE Project Team 2007). Before the CSAG recommendations, cleft lip and palate operations were performed in 57 centres in the UK, by 75 consultant surgeons, some performing only one or two primary cleft repairs a year (CSAG 1998). The outcomes for facial appearance, speech, hearing, maxillary growth and dentition were inferior to many other countries in western Europe, which had fewer cleft centres.
The CSAG report concluded that children with a cleft lip and palate should be managed by experienced teams, treating larger numbers of patients and the outcomes of these children should be monitored through national and international audits. Each multidisciplinary team should be responsible for a minimum of 80 new babies a year (Department of Health (DH) 1998), at least 70 per cent of whom will have a cleft palate (Table 1). The Health Service...