Prior to the year 2000, newborns with cleft lip and/or cleft palate (CL-CP) at Srinagarind Hospital were immediately separated from their mothers in order to be cared for in a semi-intensive care unit. The newborns were fed through a nasogastric (NG) tube since breastfeeding was not possible. However, NG tube feedings can cause serious complications, such as excessive secretions due to friction between the tube and the esophagus-upper respiratory tract, the newborn’s inability to suckle and swallow after weaning from the tube, and frequent infections. Importantly, prolonged separation could generate negative parentnewborn relationships, causing rejection and neglect of the newborn and non-adherence to the doctor appointments from feeling shame of having a newborn with CL-CP.
In 2000, the Srinagarind Hospital nursing team adopted a policy that promotes maternal-newborn relationship. Rooming in is used with all newborns with CL-CP. The mother of the newborn is instructed to hold and breastfeed her baby right after childbirth, using the football holding semi-sitting or cross-cradle sitting position. While breastfeeding, the mother is taught to support her breast with four fingers underneath and the thumb pressing on top to encourage the milk flow. The mother uses the other hand to support her baby’s neck and head, holding the baby closely to her breast, allowing the baby’s mouth to cover the whole areola. This helps to promote an appropriate latch on. When the production of mature milk increases, the newbornis able to suckle without choking. In general, the newborn with CL-CP suckles ineffectively due to the anatomical problems. This results in inadequate milk production and consumption. Nevertheless, with the mother using the appropriate breastfeeding technique, the newborn can get enough milk. To squeeze her breast properly, the mother needs to do it in tandem with the newborn’s suckling, swallowing, and breathing patterns. Based on these practices, the newborn with CL-CP can be exclusively breastfed with normal growth and development. The parent-child relationship is positive. Our multidisciplinary team has adopted this practice since 2000. A literature review showed that only one study has been reported regarding breastfeeding among newborns with CL-CP. Kogo (1997) introduced an artificial palate to 10 newborns with CL-CP and reported that 6 out of the 10 newborns could be breastfed successfully(1). However, these newborns were supplemented by the formula due to their ineffective suckling. Our research team examined Srinakarind Hospital’s January 1-October 30, 2000 statistic records and found that 14 newborns with complete CL-CP were transferred to Srinagarind Hospital. All of these 14 infants came with an NG tube and were admitted with their mothers to the 2B postpartum unit. On the unit, the mothers were instructed in the breastfeeding technique by experienced unit registered nurses (RNs). Our breastfeeding success rate was 100%. Our telephone follow-ups showed that 4 infants were exclusively breastfed for at least 4 months with normal weight and development, using Thailand Department of Health’s indicators. Based on our extensive literature review, this was the first occasion which successfully demonstrated exclusive breastfeeding among infants with complete CL-CP. Our innovative approach helps mothers whose infants are born with complete CL-CP to breastfeed their infants in a timely and appropriate manner which, in turn, helps promoting positive parentinfant relationship, enables the newborn to have normal growth and development and encourages the parents to adhere to follow up appointments. Such success had motivated our research team to look at a new group of infants with complete CL-CP. This time, our objectives were to examine:
1.Rate of exclusive breastfeeding until 6 months after the newborns’ hospitalization.
2.Factors that facilitate and hinder exclusive breastfeeding. The goal of this study was to generate and disseminate a new body of knowledge and new practices regarding exclusive breastfeeding in infants with complete CL-CP.
ก่อนปี 2000, newborns มีแหว่งหรือเพดานโหว่ (CL-CP) โรงพยาบาล Srinagarind ได้ทันทีแยกจากลูกเพื่อให้ดูแลเอาใจใส่ในหน่วยกึ่งเร่งรัดดูแล ด้านทารกแรกถูกป้อนผ่านท่อ nasogastric (NG) เนื่องจากนมแม่ไม่ได้ อย่างไรก็ตาม feedings ท่อ NG สามารถเกิดภาวะแทรกซ้อนร้ายแรง เช่นหลั่งมากเกินไปเนื่องจากแรงเสียดทานระหว่างท่อและด้านบนหลอดอาหารทางเดินหายใจ ของทารกไม่สามารถดูดนม และกลืนหลังจาก weaning จากท่อ การติดเชื้อบ่อย สำคัญ แยกเป็นเวลานานสามารถสร้างความสัมพันธ์ parentnewborn ลบ การเกิดของทารกและไม่ติดและการปฏิเสธการนัดหมายแพทย์จากรู้สึกอับอายมีทารกกับ CL-CPIn 2000, the Srinagarind Hospital nursing team adopted a policy that promotes maternal-newborn relationship. Rooming in is used with all newborns with CL-CP. The mother of the newborn is instructed to hold and breastfeed her baby right after childbirth, using the football holding semi-sitting or cross-cradle sitting position. While breastfeeding, the mother is taught to support her breast with four fingers underneath and the thumb pressing on top to encourage the milk flow. The mother uses the other hand to support her baby’s neck and head, holding the baby closely to her breast, allowing the baby’s mouth to cover the whole areola. This helps to promote an appropriate latch on. When the production of mature milk increases, the newbornis able to suckle without choking. In general, the newborn with CL-CP suckles ineffectively due to the anatomical problems. This results in inadequate milk production and consumption. Nevertheless, with the mother using the appropriate breastfeeding technique, the newborn can get enough milk. To squeeze her breast properly, the mother needs to do it in tandem with the newborn’s suckling, swallowing, and breathing patterns. Based on these practices, the newborn with CL-CP can be exclusively breastfed with normal growth and development. The parent-child relationship is positive. Our multidisciplinary team has adopted this practice since 2000. A literature review showed that only one study has been reported regarding breastfeeding among newborns with CL-CP. Kogo (1997) introduced an artificial palate to 10 newborns with CL-CP and reported that 6 out of the 10 newborns could be breastfed successfully(1). However, these newborns were supplemented by the formula due to their ineffective suckling. Our research team examined Srinakarind Hospital’s January 1-October 30, 2000 statistic records and found that 14 newborns with complete CL-CP were transferred to Srinagarind Hospital. All of these 14 infants came with an NG tube and were admitted with their mothers to the 2B postpartum unit. On the unit, the mothers were instructed in the breastfeeding technique by experienced unit registered nurses (RNs). Our breastfeeding success rate was 100%. Our telephone follow-ups showed that 4 infants were exclusively breastfed for at least 4 months with normal weight and development, using Thailand Department of Health’s indicators. Based on our extensive literature review, this was the first occasion which successfully demonstrated exclusive breastfeeding among infants with complete CL-CP. Our innovative approach helps mothers whose infants are born with complete CL-CP to breastfeed their infants in a timely and appropriate manner which, in turn, helps promoting positive parentinfant relationship, enables the newborn to have normal growth and development and encourages the parents to adhere to follow up appointments. Such success had motivated our research team to look at a new group of infants with complete CL-CP. This time, our objectives were to examine:1.อัตราของเฉพาะนมแม่จนถึง 6 เดือนหลังการรักษาในโรงพยาบาลของด้านทารกแรก2.ปัจจัยที่อำนวยความสะดวก และขัดขวางการเลี้ยงลูกด้วยนมเฉพาะ เป้าหมายของการศึกษานี้เพื่อ สร้าง และกระจายเนื้อหาใหม่ของความรู้และแนวทางปฏิบัติใหม่เกี่ยวกับนมแม่เฉพาะในทารกที่มี CL-CP ที่สมบูรณ์ได้
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