Abstract
Background
Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial.
Methods
Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores.
Results
Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5–10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5–15 days (SMD −1.10 [CI: −1.49, −0.70; P < 0.001]) and 1 month (SMD −1.23 [CI: −1.79, −0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD −0.63 [CI: −0.95, −0.31; P = 0.008]), with continued improvement at 1 month (SMD −0.41 [CI: −0.78, −0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5–7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01).
Conclusions
Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties.
Protocol registration
PROSPERO identifier CRD42022303838.
Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial.
Methods
Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores.
Results
Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5–10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5–15 days (SMD −1.10 [CI: −1.49, −0.70; P < 0.001]) and 1 month (SMD −1.23 [CI: −1.79, −0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD −0.63 [CI: −0.95, −0.31; P = 0.008]), with continued improvement at 1 month (SMD −0.41 [CI: −0.78, −0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5–7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01).
Conclusions
Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties.
Protocol registration
PROSPERO identifier CRD42022303838.
| Original language | English |
|---|---|
| Pages (from-to) | 34-42 |
| Number of pages | 9 |
| Journal | Pediatric Research |
| Volume | 95 |
| Early online date | 22 Aug 2023 |
| DOIs | |
| Publication status | Published - 1 Jan 2024 |
Bibliographical note
Funding Information:This work benefitted from a science infrastructure grant provided by the Marcus Foundation.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.