Resultados da intervenção interdisciplinar precoce em crianças com fissura labiopalatal atendidas no centro de tratamento de fissuras

Abstract

Clefts generate emotional impact and physical limitations that may need to be overcome. Earliest supports provided by a specialist identify the risk factors and correct them. This promotes a normal growth. The information about physical growth is somewhat contradictory. The purpose of the present investigation was to analyze the effect of the early support in a longitudinal growth. 138 patients were divided into two subgroups based on the time of the first visit at the center: early support until 89 days of life and late support after 90 days or more. Data collection was performed through interviews with the parents at the center. Dataincluded: feeding practice, socioeconomic factors and type of cleft. Longitudinal data was obtained by routine anthropometric measurements at birth, 1, 3, 6, 9 and 12 months. Failure to thrive was defined by the World Health Organization as weight below fifth percentile or as downward shift of two standard deviation scores. A cut-point below 3,3 ml/min was the measure index used to identify poor feeders. A comparison of the reference growth chart of World Health Organization was made between the growth assessment results of the sample,between groups. Other comparisons were made between groups. The major proportion of patients with cleft was male. About feeding efficiency, the late group had extended feeding times (0,013), poor intake (0,000), nasal regurgitation (0,047), fed bottle with cereal (0,000) and cow milk (0,000). The early group directed the nipple at the side of cleft (0,0028), had ulceration on the nasal septum (0,033), fed formula milk (0,001), fed by nasogastric tube (0,026), and had mothers with 8 or more years of study (0,004). 17% had no support at the hospital or after discharge. About type of clefts, cleft lip was breastfed (0,02) and had littlenasal regurgitation. Cleft lip and palate and cleft palate had extended feeding times (0,00), presence of nasal ulceration (0,001), was fed with cow milk (0,001) or with expressed human milk by bottle (0,03). Cleft lip and palate was associated with small families (0,042). Cleft palate was associated with micrognatia (0,02). About growth, analyzes between groups failed to demonstrate statistically significant variability. Comparisons with World Health Organization growth standards demonstrate at 1 month jeopardize for: all sample for weightfor-length (-1.77 SD) and weight-for-age (-1,45 SD). The late group for weigh-for-age, length-for-age (-1,8 and -1,05 ). At 3 months, the late group was still compromised. At 6 months all children thrived. There was relationship between guidance adopt and early group for increased intake (0,036) and supplement the remainder with spoon or cup (0,000); cleft lip and palate and cleft palate with increased intake (0,04), supplement the remainder with others devices (0,001) and supplement with vegetable oil or medium chain triglycerides (0,019); there are relationship between cleft lip and promotion of breastfeeding. The earliest support by specialists promotes better growth and feeding efficiency when we compare with World Health Organization growth standards but there wasn`t difference when we compare the groups between witch other.