Validade e confiabilidade da triagem: "teste da linguinha"

Abstract

Purpose: to verify the psychometric properties -validity and reliability -and the sensitivity, specificity and predictive values of the "Neonatal Tongue Screening Test" from the Lingual Frenulum Protocol for Infants. Methods: this is an experimental retrospective study using data from 100 newborns. The infants were assessed within the first 48 hours after birth using the Neonatal Tongue Screening Test, and subsequently assessed at 30 days of life using the Lingual Frenulum Protocol for Infants. The assessments were performed by examiner 1, who collected images and data to be analyzed by examiner 2. Newborns with lingual frenulum alterations were referred to frenotomy, reassessed 30 days after surgery and followed until six months of life. Data were used for the validation process, which included the analyses of inter-intra rater agreement, criterion validity, construct validity, sensitivity, specificity, positive predictive value, and negative predictive value. Data were statistically treated. The study was approved by the Ethics Committee under the number CAAE 40784315.9.0000.5538. Results: the "Neonatal Screening Test" was able to identify newborns with lingual frenulum alteration and the changes after frenotomy; furthermore, the results demonstrated adequate values of sensitivity, specificity, and predictive values. Concerning inter-intra rater agreement, the consistency of results demonstrated reliability and excellent repeatability. Conclusion

Is the Neonatal Tongue Screening Test a valid and reliable tool for detecting ankyloglossia in newborns?

“…When these conditions are met, the scale is considered internally consistent . Contrary to what was reported by the developers of the NTST, our assessment of its internal consistency showed that this scale is not homogeneous; its overall internal consistency is poor, half of its items do not have a similar item–test correlation, one item presents a lower than recommended item–test correlation (i.e., 0.30), and two items (i.e., lip posture at rest and frenulum thickness) are inversely correlated with the scale formed by all other items…”

Tongue position for lingual frenulum assessment

“…These findings demonstrated that tongue elevation is the position that allows for the best observation of the shape of the tip of the tongue, being possible to identify, more accurately, the presence of V-shaped or heart-shaped tip in subjects with ankyloglossia. Thus, those findings agree with proposals of most assessment tools 5,6,8,[12][13][14][17][18][19][20][21][22][31][32][33] .…”

“…Several lingual frenulum assessment tools for infants, children, adolescents, and adults have been published by professionals, such as dentists, lactation consultants, midwives, speech-language pathologists [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

“…Most authors recommend tongue elevation for diagnosing ankyloglossia [5][6]8,[12][13][14][17][18][19][20][21][22] . A few authors propose tongue protrusion for assessing the lingual frenulum 7,11,15 .…”

Response to Letter to the Editor regarding the article: Is the neonatal tongue screening test a valid and reliable tool for detecting ankyloglossia in newborns?

“…• we were not able to find any differences between the versions of the NTst printed in the LFPI Manual 16 and in the paper published by Martinelli et al in 2016. 2 According to Dr. Martinelli's letter, we should have used the latter because this would be the validated version of the instrument published in 2014. Ironically, the Law establishing the mandatory screening of Brazilian newborns for ankyloglossia using the NTst was passed in 2014.…”