Faltering weight in infants with cleft lip and palate.

Feeding in neonates with clefts can be challenging, and faltering growth is frequently observed. Inadequate nutrition can delay surgery and may impact recovery including wound healing. Since the restructuring and centralisation of cleft services in the UK following the Clinical Standards Advisory Group report in 1998, there has been an emphasis on a multidisciplinary team approach and integration of a nurse specialist. This involves feeding assessment within 24 h of referral and provision of support, including access to feeding adjuncts. The aim of this study was to review data from our regional cleft centre to demonstrate how this change in service provision has impacted patient nutrition. We present the findings of our review of patients who underwent cleft lip and/or palate repair at our centre between 1 January 2018 and 31 December 2019. In particular, we noted the birth weight, gestational age, type of cleft, presence of syndrome or sequence, weight and age during the primary surgery. These data were collected from 97 patients across 2 hospital sites from all patients who underwent cleft surgery within the given time. Their centile on the growth chart was calculated at birth, primary surgery and at later surgery. This allowed us to identify patients whose weight was not progressing appropriately and to demonstrate that early feeding assessment and intervention help to address and prevent faltering weight. We summarised our findings with accompanying statistical analysis and reference to previously reported data since the centralisation of UK Cleft services.