Neonatal cleft lip repair in babies with breastfeeding difficulties at Polokwane Mankweng Hospital Complex

Background. A cleft lip (CL) is a congenital abnormality resulting from failure of union of the medial and nasal prominences with the maxillary prominence during embryonic development. CL may be classified as incomplete, complete, unilateral, bilateral or median. It may be associated with a cleft alveolus or a cleft palate. Definitive correction of a cleft lip is by surgery. In most African settings, the birth of a cleft lip and cleft palate (CLP) baby is associated with witchcraft and ancestral spirits. The parents, particularly mothers, are stigmatised. Objective. To repair CLs in neonates with difficulties in breastfeeding. Methods. Non-syndromic term neonates referred to Polokwane Mankweng Hospital Complex (PMHC) from primary and secondary hospitals with CLP and difficulties in breastfeeding were prospectively admitted to the neonatal unit. Our breastfeeding team supervised and assisted them with breastfeeding. The neonates whose breastfeeding was found to be unsatisfactory were considered for neonatal CL repair. Those who breastfed adequately were booked for later lip repair as per the rule of tens and discharged. Results. From June 2009 to March 2012, 60 children with CLP were referred to PMHC, including 36 neonates. Of these, 23 neonates were unable to breastfeed satisfactorily and were operated at a median age of 9 (range 3 - 28) days. The median weight was 2.8 (1.8 - 3.7) kg. The median haemoglobin was 13.1 (11.5 - 16) g/dL. Conclusion. Neonatal CL repair is an alternative for those with breastfeeding difficulties. Eagerness to breastfeed increased following the lip repair with subsequent improvement in maternal confidence and interaction with the baby. At follow up, weight gain was above the 50th centile on the road to health charts. Early surgery prevents exposure of CL to the public with highly positive possible outcome of decreasing the potential for stigmatisation.