6442 Frenulectomy as management for tongue-tie in breastfeeding problems: a rapid review

Résumé fourni par la source

Objectives Tongue-tie (ankyloglossia) is a common condition affecting up to 60 000 babies each year in the UK, and is characterised by a short lingual frenulum that may restrict tongue tip mobility.1 275% of infants with tongue-tie are asymptomatic and do not experience feeding difficulties.2 Despite this, the rates of frenulectomy (surgical division of the lingual frenulum) in relation to breast-feeding difficulties in high-income countries have quadrupled over the past 10 years.3 Operation rates are highest in babies of first-time mothers, and mothers that are more affluent.4 Frenulectomy risks include bleeding, infection, discomfort and condition recurrence.4 There remains a lack of consensus regarding diagnosis and treatment of tongue-tie globally, and guidance is changing over time.3 5 A rapid review was conducted to establish the current evidence base for the use of frenulectomy as management for tongue-tie in babies with breastfeeding problems. Methods A structured literature search was conducted using PubMED. A grey literature search was conducted using search engines and NICE guidelines. All data published before 03/11/22 was reviewed. Inclusion and exclusion criteria were applied. No limit was set by date published or article language. Papers focusing on frenulectomy for speech difficulties were excluded. Results 9 articles were included in the rapid review, consisting of systematic reviews, narrative reviews, RCTs, prospective cohort studies, and guidelines. All articles highlighted the lack of robust evidence to support frenulectomy in the management of tongue tie in breastfeeding problems, due to small sample sizes and high risk of bias. A systematic review demonstrated a reduction in nipple pain for the mother, but no consistent positive effect on breastfeeding. A prospective RCT showed evidence of improvement in feeding in infants undergoing frenulectomy, however the sample size was very small, introducing bias. Rates of complications were low in infants undergoing frenulectomy. Conclusion There is little high-quality evidence to support frenulectomy for the management of tongue tie in breastfeeding problems. There may be some evidence to support frenulectomy in a limited number of cases. Clinicians should consider a multifactorial evaluation of other potential factors contributing to breastfeeding problems before referral for frenulectomy. Clinicians can support mothers concerned about breastfeeding problems and ankyloglossia by explaining the limited evidence for frenulectomy, and signposting to other support, including lactation experts. There is a need for further, high-quality RCTs in order to inform clinical guidelines in the management of ankyloglossia. References Rowan-Legg A. Ankyloglossia and breastfeeding. Paediatric Child Health. 2015. LeFort Y, et al. Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads. Breastfeeding Medicine. 2021. O’Shea JE, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Systematic Review. 2017. Van Biervliet S, et al. Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted. European Journal of Pediatrics. 2020. Power RF, et al. Tongue-tie and frenotomy in infants with breastfeeding difficulties: achieving a balance. Arch Dis Child. 2014.

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