Friday, July 22, 2011

Release of Tongue-Tie in Neonates Immediately Improves Breastfeeding

From Reuters Health Information

NEW YORK (Reuters Health) Jul 20 - Frenotomy in newborns with significant ankyloglossia rapidly improves breastfeeding scores and reduces maternal nipple pain, according to the results of a small randomized trial.
The authors say their findings "should now provide compelling evidence for pediatricians, otolaryngologists, oral surgeons, and lactation consultants to seek frenotomy when indicated."
Dr. Melissa Buryk and colleagues at the Naval Medical Center in Portsmouth, Virginia, point out that release of the lingual frenulum is often performed in infants with ankyloglossia who have difficulty breastfeeding, but the practice is controversial and there's been a lack of supporting data.
To investigate, the team enrolled significantly ankyloglossic neonates, whose mothers reported breastfeeding problems or nipple pain, in a randomized study. At a mean age of 6 days, 30 infants had a simple frenotomy and 28 had a sham procedure in which nothing was done, without the mothers being present or made aware of which group their child was in.
Frenotomy produced an immediate improvement in nipple pain and breastfeeding scores, the investigators found. The results are reported in the August issue of Pediatrics.
At 2 weeks' follow-up, maternal nipple pain as measured on the Short-Form McGill Pain Questionnaire (SF-MPQ) had dropped in both groups from pre-intervention levels, but more so in the frenotomy group (p<0.001). Specifically, the score declined from 16.77 to 4.9 and from 19.25 to 13.5 in the frenotomy and sham groups, respectively.
Breastfeeding scores measured by the Infant Breastfeeding Assessment Tool (IBFAT) hardly changed in the sham procedure group, but improved from 9.3 to 11.6 in the frenotomy group, according to the report.
Infants in the sham group were given a frenotomy at or before 2 weeks if the parents wished, and all but one opted to do so. Therefore further comparison between groups was no longer possible, the authors note.
"As in previous studies, we found the procedure to be rapid, simple, and without complications," Dr. Buryk and colleagues comment.
"Additional studies should be done to determine the optimal timing of frenotomy and the ideal screening tool to detect significant ankyloglossia," they suggest.
Pediatrics 2011.

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