Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

BACKGROUND: Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES: This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA: Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS: Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS: Five RCTs with a total of 292 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (two studies). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No difference was shown for infants fitted with a maxillary plate compared to no plate. However, there was some evidence of an effect on weight at 6 weeks post-surgery in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% confidence interval 0.20 to 0.74). AUTHORS' CONCLUSIONS: Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that breastfeeding is better than spoon-feeding following surgery for cleft. There was no evidence to suggest that maxillary plates assist growth in babies with clefts of the palate. No evidence was found to assess the use of any types of maternal advice and/or support for these babies

Development and evaluation of elastomeric materials for geothermal applications

A material for a casing packer for service for 24 hours in a geothermal environment was developed by synthesis of new elastomers and formulation of available materials. Formulation included use of commercial elastomer gumstocks and also crosslinking of plastic (high Tg) materials. Fibrous reinforcement of fluorocarbon rubbers was emphasized. Organic fiber reinforcement did not increase hot properties significantly. Glass fiber reinforcement gave significant increase in tensile properties. Elongation was reduced, and the glass-reinforced composition examined so far did not hold up well in the geothermal environment. Colloidal asbestos fibers were also investigated. A few experiments with polyphenyl ether gave material with low tensile and high compression set. Available high styrene SBR compositions were studied. Work to date suggests that new synthetic polymers will be required for service in geothermal environments

Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?

Summary Background Healthcare associated infections (HAI) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HAI and contain antimicrobial resistance (AMR). Aim To measure the prevalence of HAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. Methods A national rolling PPS in National Health Service (NHS) acute, NHS non-acute, NHS paediatric and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. Findings The prevalence of HAI was 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most common HAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3% and 13.8% in acute adults, paediatric and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal and urinary tract infections were the most common infections being treated at the time of survey. Conclusion HAI continues to be a public health concern in Scotland. UTI and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings