Aleitamento materno e fissuras labiopalatinas : revisão sistemática e meta-análise

Abstract

Resumo : Objetivo: Avaliar se a presença de fissuras labiopalatinas (FLP) está associada à ausência de aleitamento materno (AM). Métodos: Para esta revisão sistemática, a estratégia de busca foi realizada nas bases PubMed, Scopus, Web of Science, Chochrane Library, LILACS, BBO, Embase e na literatura cinzenta. Foram selecionados estudos observacionais que avaliaram o AM associado às FLP. O risco de viés foi analisado de acordo com Newcastle-Ottawa Scale. Para meta-análise, considerou-se a ocorrência de AM em relação à ocorrência FLP, e ao tipo de FLP (fissura palatina com e sem envolvimento de lábio, respectivamente, FLP e FP; e fissura labial (FL)). Avaliou-se ainda a associação entre o tipo de FLP e a presença de desafios no AM. Resultados: 6883 estudos foram identificados, 29 foram incluídos na revisão qualitativa e 9 na meta-análise. O risco de viés foi moderado e alto para a maioria dos estudos (n= 26). Observou-se associação significativa entre a presença de FLP e ausência de AM (OR=18,08; IC95% 7,09-46,09).Ainda, houve maior frequência de desafios relacionados ao AM e ausência de AM entre indivíduos com FP e FLP do que indivíduos com FL (OR=13,55; IC95% 4,91-37,43 e OR=5,93; IC95% 4,30-8,16 respectivamente). A certeza da evidência foi baixa ou muito baixa para todas as análises.Conclusão: Indivíduos com FLP apresentaram menor frequência de AM em relação aos indivíduos sem FLP. Tanto ao tipo de fissura, as fissura com envolvimento palatino apresentaram menor frequência de AM e tiveram maiores desafios relacionados ao AM quando comparados àqueles com envolvimento somente do lábio.

Abstract : Objective: To evaluate the association between the presence of cleft lip and palate (CLP) and the absence of breastfeeding (BF). Methods: For this systematic review, the search strategy was performed in PubMed, Scopus, Web of Science, Chochrane Library, LILACS, BBO, Embase and in the gray literature. Observational studies that evaluated BF associated with CLP were selected. The risk of bias was analyzed according to Newcastle-Ottawa Scale. For the random-effects meta-analysis, the frequency of BF was considered in relation to the presence or absence of OFC, as well as the type of CLP (cleft palate with and without involvement of lip – CLP and CP, respectively – and cleft lip – CL). The association between the cleft type and BF’ challenges was also evaluated. Results: a total of 6883 studies were identified, 29 were included in the qualitative review, and 9 in the meta-analysis. The risk of bias was moderate and high in most studies (n=26). There was a significant association between the absence of BF (OR=18.08; 95%CI 7.09-46.09) and the presence of CLP. Individuals with CP and CLP had a lower frequency of BF (OR=5.93; 95%CI 4.30-8.16), and a higher frequency of challenges in BF (OR=13.55; 95%CI 4 .91-37.43) in relation to individuals with CL. The certainty of the evidence was low to very low in all analysis. Conclusion: Individuals with CLP had a lower frequency of BF compared to individuals without CLP. Individuals with cleft palate involvement had a lower frequency of BF and presented more challenges to perform BF compared to those with only lip involvement.