A Quality Improvement Initiative to Improve Feeding and Growth of Infants With Cleft Lip and/or Palate

Objective: The purpose of this quality improvement initiative was to improve feeding and growth outcomes in infants with cleft lip and/or palate (CL/P). Design: Institute for Healthcare Improvement quality improvement model. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: One hundred forty-five infants with nonsyndromic CL/P ages 0 to 12 months. Interventions: Key drivers included (1) caregiver education and resources, (2) care coordination and flow, and (3) provider education and training. Interventions were designed around these themes and included targeting improved team communication, increased social work consultations, patient tracking, staff education, improved access to feeding equipment, and the launch of a new cleft palate feeding team. Main Outcome Measure(s): The primary outcome measure was the percentage of new patients with CL/P who met criteria for failure to thrive (FTT) per month. The secondary outcome measure was the frequency of hospitalization for infants with CL/P with a primary reason for admission of feeding difficulties or FTT. Results: The institutional FTT rate for infants with CL/P decreased from 17% to 7% (P < .003). The frequency of hospitalization for FTT improved from once every 30 days to once every 118 days. Conclusions: Targeted interventions aimed at improving feeding efficiency and effectiveness, as well as changes in care delivery models, can reliably promote improvements in feeding and growth outcomes for infants with CL/P, even with psychosocial risk factors present.