Randomised controlled trial of early frenotomy in breastfed infants with mild–moderate tongue-tie

Abstract

Trial designA randomised, parallel group, pragmatic trial.SettingA large UK maternity hospital.ParticipantsTerm infants <2 weeks old with a mild or moderate degree of tongue-tie, and their mothers who were having difficulties breastfeeding.ObjectivesTo determine if immediate frenotomy was better than standard breastfeeding support.InterventionsParticipants were randomised to an early frenotomy intervention group or a ‘standard care’ comparison group.OutcomesPrimary outcome was breastfeeding at 5 days, with secondary outcomes of breastfeeding self-efficacy and pain on feeding. Final assessment was at 8 weeks; 20 also had qualitative interviews. Researchers assessing outcomes, but not participants, were blinded to group assignment.Results107 infants were randomised, 55 to the intervention group and 52 to the comparison group. Five-day outcome measures were available for 53 (96%) of the intervention group and 52 (100%) of the comparison group, and intention-to-treat analysis showed no difference in the primary outcome—Latch, Audible swallowing, nipple Type, Comfort, Hold score. Frenotomy did improve the tongue-tie and increased maternal breastfeeding self-efficacy. At 5 days, there was a 15.5% increase in bottle feeding in the comparison group compared with a 7.5% increase in the intervention group.After the 5-day clinic, 44 of the comparison group had requested a frenotomy; by 8 weeks only 6 (12%) were breastfeeding without a frenotomy. At 8 weeks, there were no differences between groups in the breastfeeding measures or in the infant weight. No adverse events were observed.ConclusionsEarly frenotomy did not result in an objective improvement in breastfeeding but was associated with improved self-efficacy. The majority in the comparison arm opted for the intervention after 5 days.

Classificação anatômica do frênulo lingual de bebês

“…This criterion may have influenced the high index of altered frenulum, since the suction was not considered as a classification parameter and its frequency of alterations was low, which could decrease the altered frenulum index. Regarding the altered frenulum prevailed male babies, in agreement with previous studies [10][11][12][13][14][15]18,23 .…”

“…Among the others studies, only one 18 reported gender of the sample, with a prevalence of male. Other reviewed studies only mentioned gender in the prevalence of alteration of the frenulum [10][11][12][13][14][15]18,23 .…”

“…Previous studies have classified the altered frenulum babies as ankyloglossia 1,[12][13][14][15] , lisp 1,10,11 or simply change the frenulum 23 . Part of the studies 10,11,14,15 used Hazelbaker protocol to classify the frenulum and the other part did not mention the criteria and instruments used 12,13,16,17,19,20,23 .…”

“…Part of the studies 10,11,14,15 used Hazelbaker protocol to classify the frenulum and the other part did not mention the criteria and instruments used 12,13,16,17,19,20,23 .…”

“…There is considerable controversy among health professionals regarding the classification of the lingual frenulum altered 9 . Different classifications are found in the literature: lisp 1,10,11 ; ankyloglossia 1,[12][13][14][15] ; short frenulum, long frenulum, frontal lisp 1 ; short mucosal, long mucosal with mandibular fixing and hypertrophic with fixing the alveolar ridge 12 ; short, anterior fixation and short with anterior fixation 4,16 and altered frenulum 8,17,18 .…”