الفهرس 
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Abstract
Orofacial clefts are the most commonly occurring craniofacial defect with an average prevalence of 1.2/1000 live births. Children born with an orofacial cleft have a high burden of care throughout their childhood. Most can expect at least one surgical intervention requiring general anaesthetic, speech therapy, dental and orthodontic treatment, and possibly psychological counselling associated with the appearance of their cleft. The clinical consensus is that breast feeding is the preferred choice for neonates feeding. The World Health Organisation recommends exclusive breast feeding for 6 months.
This study was aimed to assess the mother’s knowledge and practices regarding breast feeding patterns for neonates with cleft lip and palate.
Research Question
• What are the patterns of breast feeding among neonates with Cleft Lip and Palate?
• What are the levels of mothers’ knowledge regarding breast feeding patterns for neonates with Lip and CL/CP?
• What are the levels of mothers’ practice regarding breast feeding patterns for neonates with CL/CP?
The subject and methods of the current study discussed under the following four (4) designs:
I. Technical Design
II. Operational Design
III. Administrative Design
IV. Statistical Design
I, Technical Design
A descriptive design was used to conduct this study.
Setting
This study was conducted at the NICU and the Inpatient Surgical Department and Outpatient Surgical Clinic affiliated to children Ain Shams University Hospitals.
Sample
A purposive sample composed of (68) mothers have neonates with cleft lip and palate from the previously mentioned settings for 6 months under the following criteria
The inclusion criteria:
1. Neonates from both genders.
2. Neonates age from birth to one month.
3. Neonates diagnosed as unrepaired cleft lip and /or palate
Exclusion criteria:
1. Neonates born earlier than 34 weeks gestation
2. Neonates with other chronic diseases of the surgical disorder.
Data Collection Tools
Data collected by using two tools:
IV. Interviewing Questionnaire: the researcher developed it after reviewing the relevant literature. It was written in simple Arabic language. It was consist of four parts:
Part 1: It was concerned with the characteristics of study subjects:
• Characteristics of the studied neonates as age, gender, weight, diagnosis
• Characteristics of the studied mothers such as age, rank, mother’s age, level of education, occupation and residence
• Characteristics of the family as, number of family members, income and family history of cleft lip and palate.
Part 2: It concerning with: Feeding patterns of breast feeding among neonates with Cleft Lip and Palate. In addition to the studied neonates, illness history include evaluation of neonate feeding on their mothers as feeding method, time for complete feeding, difficulty during feeding, nutritional supplement, kind of supplement, feeding position, neonates appetite and stress during feeding
Part 3: It is concerned with the assessment of the studied growth parameters of neonates.
Part II: It concerned with levels of mothers’ knowledge regarding breast feeding patterns for neonates with CL/CP.
Scoring system:
According to the answers obtained from the mothers, a scoring system was followed to assess the mother’s knowledge each question scored one (1) for the correct answer and each incorrect answer, scored zero (0). The score of questions was summed up and the total divided by a number of the items, giving a mean score. These scores were converted into a percent score and classified as the following:
• < 50% unsatisfactory knowledge.
• ≥ 50% satisfactory knowledge
II. Observational Checklist: It was used to assess the mother’s practices of breast feeding methods. It was consisted of:
• Breast care (13 steps).
• Breast feeding (33 steps)
• hand expressing breast milk (17 steps)
• Manual/hand breast pumps (11 items)
• Electric pumps (18 steps).
• Bottle feeding (34 steps).
• Combined feeding (15 steps).
• Syringe feeding (14 steps).
Scoring system:
The done step was scored one, and that not done was scored zero. The score of steps was summed-up and the total was divided by a number of the steps, giving a mean score. These scores were converted into a percent score and classified as the following:
• < 60% inadequate practices
• ≥ 60% adequate practices
III. Operational Design
Preparatory Phase
This phase included reviewing literature related to mothers’ knowledge regarding breast feeding patterns for neonates with lip and CL/CP. This served to develop the study tools for data collection. During this phase, the researcher also visited the selected places to be acquainted with the personnel and the study settings. Development of the tools was under supervisors’ guidance and experts’ opinions considered.
Validity and reliability
Content validity was ascertained by a group (5) of the experts in the field of pediatric nursing to test its content validity and applicability, Reliability was don used test-retest (0.80).
Pilot Study
A pilot study carried out on 10% (7) of mothers who attended at the previously mentioned settings to test the applicability of the constructed tools and the clarity of the included questions related to mothers’ knowledge regarding breast feeding patterns for neonates with CL/CP. The pilot has also served to estimate the time needed for each subject to fill in the questions. According to the results of the pilot, some corrections such as rephrasing and added questions performed as needed. The pilot participants were not included in the main study sample.
Fieldwork
The actual fieldwork of this study was carried out over 6 month period. The researcher was available 4 days/week. Each mother was interviewed individually to gather the necessary data for the study. As regards the mother’s practices, it was assessed by the researcher and the mothers were asked to give their responses according to the study tools. The average time consumed to fill in the tools about a range of 40 minutes.
V. Administrative Design
Approval was obtained through an issued letter from the Dean of Faculty of Nursing, Ain Shams University to the Director of the Children’s Hospital affiliated to Ain shams University Hospitals. The researcher then met the hospital director and explained the purpose and the methods of the data collection.
Ethical Consideration
The research approval was obtained from the Research Ethical Committee of Faculty of Nursing, Ain Shams University before starting the study. Verbal approval was obtained from the mothers before inclusion in the study; a clear and simple explanation was given according to their level of understanding. They secured that all the gathered data as confidential and used for research purposes only. The mothers informed that they are allowed to choose to participate or not in the study and they have the right to withdraw from the study at any time.
VI. Statistical Design
Data collected from the studied sample was revised, coded and entered using. PC. Computerized data entry and statistical analysis were fulfilled using the statistical package for social sciences (SPSS) version 20. Data were presented using descriptive statistics in the form of frequencies, percentages. Chi-square test(X2) used for comparisons between qualitative variables. So, the p-value was considered significant as the following:
• P-value <0.05 was considered significant.
• P-value <0.001 was considered as highly significant.
• P-value >0.05 was considered insignificant.
Results:
• 55.9% of the studied mothers are in the age group 30 < 35 years with mean age 32.11±2.67 years and 32.4% of them have basic education.
• 70.6% of the studied mothers are housewives, while 29.4% of them are working.
• 63.2% of the studied mothers live in rural areas, while 36.8% of them live in urban areas.
• 66.2 % of the studied mothers have relative relation with their husbands
• 88.2% of them have no family history of cleft lip and cleft palate. 69.1% of the studied mothers don’t have enough monthly income.
• 83.8 % of the studied mothers have a family of more than five members
• 39.4% of the studied neonates are in the aged between 7<14 days with a mean age of 5.71±5.9 days and 57.4% of them are females.
• 83.8% of the studied mother received nutritional instructions for their neonates with cleft lip and cleft palate at the hospital
• 73.7% of them received nutritional instructions from the doctor.
• 63.2% of the studied mother are unsatisfied with nutritional instructions for their neonates with cleft lip and cleft palate.
• 50% of the studied neonates are arranged as third and more children in their family, while 33.6% of them are arranged, children.
• 39.7 of the studied neonates have unilateral cleft lip
• 66.2% % of them have aspiration as common symptoms’ at birth.
• 67.6% of them detected their cleft lip and palate immediately after birth
• 82.4% of the studied neonates discovered by the doctor.
• 79.4% of the studied neonates were admitted to the hospital and 63 % % of them admitted twice
• 64.7% of the studied neonates received nutritional supplements.
• 79.6% and 59.3% of them were admitted due to malnutrition and pneumonia respectively.
• 51.5 % of the studied neonates are currently admitted to the hospital to doing surgical repair and 51.5% of them are planned to doing surgery respectively.
• 70.6% of the studied mothers have unsatisfactory knowledge regarding breast feeding patterns for the neonate with cleft lip and cleft palate, while 29.4% of them have satisfactory knowledge regarding breast feeding patterns for the neonate with cleft lip and cleft palate.
• 67.6% of the studied mothers have incorrect practices regarding breast feeding patterns for the neonate with cleft lip and cleft palate, while 32.4% of them have correct practices regarding breast feeding patterns for the neonate with cleft lip and cleft palate.
• There are highly statistically significant differences between education, occupation and residence of the studied mothers and their knowledge of the studied mothers regarding breast feeding patterns for neonates with cleft lip and palate
• There are no statistically significant differences in age of the studied mothers and their knowledge of the studied mothers regarding breast feeding patterns for neonates with cleft lip and palate.
• There are highly statistically significant differences between occupation and residence of the studied mothers and their practices of the studied mothers regarding breast feeding patterns for neonates with cleft lip and palate, meanwhile.
• there are no statistically significant differences in age and education of the studied mothers and their practices of the studied mothers regarding breast feeding patterns for neonates with cleft lip and palate.
• There is a statistically significant difference between the level of knowledge of the studied mothers and their neonate’s breast feeding patterns.
• There is a highly statistically significant difference between level practices of the studied mothers and their neonate’s breast feeding patterns.
Conclusion
The current study showed that, the results showed that, more than two thirds of the studied mothers have unsatisfactory knowledge regarding breast feeding patterns for the neonate with cleft lip and cleft palate. Two thirds of the studied mothers have incorrect practices regarding breast feeding patterns for the neonate with cleft lip and cleft palate. Finally, there is a highly statistically significant difference between level of knowledge, practices of the studied mothers and their neonate’s breast feeding patterns.
Recommendations
Based on the findings of the present study, the following recommendations made:
• Develope feeding guidelines for neonate with cleft lip and palate
• Enhance feeding protocol for mothers having neonates with cleft lip and palat
• Continuous an educational program should be designed and implemented for mothers having neonate with cleft lip and cleft palate.
• Encourage mothers to overcome feeding difficulties regarding their neonates with cleft palate and lip
• Depeloe a strategies to establish and maintain the mother’s milk supply, support breast feeding, assess pacing of feeding, and use of adaptive feeding devices were described.
• Conducte future research to assess the awareness of mothers and most importantly to investigate the effect of feeding practices of neonate with a cleft on their growth and development.