A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study

Abstract

Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.

Complications following frenotomy for ankyloglossia: A 24‐month prospective New Zealand Paediatric Surveillance Unit study

“…The annualised incidence rate of frenotomy complications for children under 1 year old presenting to hospital‐based paediatricians in New Zealand was 13.9/100 000 (95% confidence interval 7.96–22.6), with a high estimate of 20/100 000 if non‐responders were included . Rates of complications by region are presented in Table .…”

“…Geographic variation is noted with a peak of 85.6/100 000 in Otago/Southland, and 0/100 000 in Canterbury. Notably, Canterbury had a centralised referral pathway (aiming to reduce unnecessary frenotomies) implemented 4 months after the start of our data collection . National frenotomy rates are unknown, but for Otago/Southland this is estimated as at least 12 133/100 000 (based on the audit), which would equate to an estimated moderate to severe complication rate for this region of approximately 1% for babies undergoing the procedure.…”

“…Parents/families need to be advised accordingly, and steps need to be taken to actively minimise the risk of these complications occurring. In the diagnosis and management of ankyloglossia, centralised guidelines with freely accessible breastfeeding support and timely access to specialist second opinions should be considered as the ideal model, as shown with the successful Canterbury approach …”

“…Canterbury, another New Zealand region, has reported a process of developing an evidence‐based local pathway (Fig. ) for referral, assessment and treatment of ankyloglossia with the aim of limiting unnecessary surgery, reducing their frenotomy rate from 11.5 to 3.6% over a 2‐year period . They used a Bristol tongue‐tie assessment tool score ≤ 4 (score 0–3 indicates severe reduction of tongue function) performed in a timely fashion by a specifically trained professional as the threshold for obtaining funded frenotomy, with skilled breastfeeding assessment and support.…”

“…Example of successful pathway for tongue‐tie release for babies with breast feeding difficulties (summary of canterbury District Health Board local pathway).…”