Benchmarking clinical practice against best evidence: An example from breastfeeding infants with cleft lip and/or palate

Abstract

The purpose of this paper was to systematically review the literature to determine the feasibility of breastfeeding children with cleft lip and/or palate (CL+/−P) and determine whether Australian cleft-unit guidelines reflect best practice. The methodology used was a systematic review of the literature regarding breastfeeding for infants with CL+/−P. Guidelines regarding the breastfeeding of infants with CL+/−P from Australian cleft units were also reviewed. We then compared these guidelines against evidence from the systematic review to determine whether Australian cleft units were basing clinical management on current best evidence. Results suggested that infants with a cleft lip may breastfeed with few difficulties, whilst infants with a cleft palate or cleft lip and palate typically present with greater feeding difficulties and thus require bottle-feeding in conjunction with breastfeeding to meet their nutritional needs. However, much of the evidence was considered weak. Breastfeeding guidelines were provided by 7/9 cleft units. Of the 17 different recommendations made across the guidelines, 76% (13/17) were supported by evidence. The main conclusion drawn was that current best evidence supports breastfeeding for all children with CL+/−P, but children with cleft palate and cleft lip and palate will typically require additional nutritional supplementation with bottle-feeding. There was fair adherence to evidence-based practice in Australia, with the majority of guidelines being underpinned by evidence. Speech–language pathologists working with different populations who are interested in benchmarking their institution's clinical care against current best evidence and nationwide practice could use methodology similar to that applied in the present study.

Keywords:

• Cleft lip
• Cleft palate
• Breastfeeding.

Declaration of interest: The authors have no conflicts of interest and are solely responsible for the content of this article.

Notes

Source of funding: No source of funding reported.