Feeding difficulties in infants with unrepaired cleft lip and palate and HIV-exposure

Abstract

Background: There is limited description of the feeding characteristics of infants with unrepaired cleft lip and palate (CLP), exposed to HIV and antiretroviral treatment. Objective: To determine whether the feeding characteristics of very young infants with unrepaired CLP and HIV-exposure (HIV-E) differ significantly to that of infants with unrepaired CLP only. Method: A two-group comparative design with a validated measure, the Neonatal Feeding Assessment Scale (Viviers, 2016) was used. The effectiveness of oral feeding skills (OFS) between the two groups were measured based on the objective measure described by Lau and Smith (2011). Twelve participants with unrepaired CLP and HIV-E and 13 with unrepaired CLP were matched according to cleft type and use of feeding obturator. There were no significant differences between the groups for mean age, birth weight and gestation. Participants were between two and 89 days old, bottle fed, and had no syndrome/co-occurring disorder. Results: Nine (75%) participants in the research group (RG) and only two (15.38%) in the control group (CG) presented with the likelihood of oropharyngeal dysphagia (OPD). Apart from feeding difficulties as a result of structural impairment of the cleft, the RG showed symptoms of neurological involvement, such as absent rooting. The RG consumed less milk in the same time than the CG. The RG experienced more problems since birth as they were in the neonatal intensive care unit for longer and took longer to achieve successful bottle feeding. Conclusion: The RG presented with distinctive symptoms of OPD. More studies using different measuring tools, such as the Modified Barium Swallow Study are required to strengthen the evidence.