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Thomas J, Bunik M, Holmes A, Keels MA, Poindexter B, Meyer A, Gilliland A. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics 2024; 154:e2024067605. [PMID: 39069819 DOI: 10.1542/peds.2024-067605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024] Open
Abstract
Ankyloglossia refers to a congenitally tight lingual frenulum that limits the motion of the tongue. Whether the release of a tight lingual frenulum in neonates improves breastfeeding is not clear. Because many of the symptoms of ankyloglossia overlap those of other breastfeeding difficulties, a team partnership is necessary.
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Affiliation(s)
- Jennifer Thomas
- Department of Pediatrics, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Maya Bunik
- Department of Pediatrics, University of Colorado, School of Medicine, and Children's Hospital Colorado, Aurora, Colorado
| | - Alison Holmes
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Dartmouth Health Children's/Geisel School of Medicine, Lebanon, New Hampshire
| | - Martha Ann Keels
- Department of Pediatrics, Duke University, and Division of Pediatric Dentistry and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Brenda Poindexter
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Anna Meyer
- Department of Pediatrics, University of California San Francisco School of Medicine, and University of California San Francisco Benioff Children's Hospital San Francisco, San Francisco, California
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Batista CLC, Pereira ALP. Influence of Neonatal Ankyloglossia on exclusive breastfeeding in the six first months of life: a cohort study. Codas 2024; 36:e20230108. [PMID: 38922259 PMCID: PMC467001 DOI: 10.1590/2317-1782/20242023108pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 06/27/2024] Open
Abstract
PURPOSE To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. METHODS Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). RESULTS Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. CONCLUSION Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.
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Affiliation(s)
| | - Alex Luiz Pozzobon Pereira
- Programa de Pós-graduação em Odontologia, Universidade Federal do Maranhão – UFMA - São Luís (MA), Brasil.
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Feitosa ALF, da Silva GRN, Moya MP, Martinelli RLDC, da Silva MGP. Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study. Breastfeed Med 2023; 18:528-533. [PMID: 37428528 DOI: 10.1089/bfm.2022.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Objective: To determine the prevalence of ankyloglossia in diamniotic monochorionic and diamniotic dichorionic twins, as well as to verify the relationship between gender and type of pregnancy. Study Design: A cross-sectional observational study, carried out with 52 pairs of dichorionic/diamniotic twins and 49 monochorionic/diamniotic pairs. The data collection was carried out through the analysis of medical records and the results of the Neonatal Screening of the Tongue Frenulum Assessment Protocol in Babies, and corresponded to the period of 2 years (2020-2022). Statistical analysis of data was performed, considering the significance value of 5%. The study was approved by the Human Research Ethics Committee of the institution. Results: The statistical analysis of multiple logistic regression between the two groups of twins (Mono/Di and Di/Di) according to the socioeconomic, demographic, and clinical-epidemiological profile was statistically significant for some variables. The prevalence of ankyloglossia, according to the type of twin pregnancy, showed a statistically significant difference. There was no statistical difference in relation to sex and ankyloglossia, or between couples diagnosed with ankyloglossia according to the type of pregnancy. Conclusion: Monochorionic/diamniotic twins had a higher prevalence of ankyloglossia, regardless of gender.
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Affiliation(s)
| | | | - María Paz Moya
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | | | - Maria Gabriella Pacheco da Silva
- Neonatology Service, Centro Universitário Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Brazil
- Universidade de Pernambuco (UPE), Recife, Brazil
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Cruz PV, Souza-Oliveira AC, Notaro SQ, Occhi-Alexandre IGP, Maia RM, De Luca Canto G, Bendo CB, Martins CC. Prevalence of ankyloglossia according to different assessment tools. J Am Dent Assoc 2022; 153:1026-1040.e31. [DOI: 10.1016/j.adaj.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
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Batista CLC, Pereira ALP. Does neonatal ankyloglossia interfere in the growth of infants during the first 6 months of life? A case series nested in a cohort study. J Med Case Rep 2022; 16:394. [PMID: 36307818 PMCID: PMC9617444 DOI: 10.1186/s13256-022-03578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankyloglossia is commonly reported as one of the major causes of breastfeeding difficulty. There is a lack of research on infant growth and latching performance with clinical measures. CASES PRESENTATION We describe a series of eight clinical cases (three female and five male infants) in a specialized breastfeeding center in a tertiary hospital in Northeast Brazil. The mothers were of mixed race and ranged from 13 to 41 years of age. Ankyloglossia was diagnosed within the first 48 hours after delivery. We measured the standards of growth, the mothers' perception of breastfeeding, and a pain indicator, and performed an assessment of breastfeeding. The regularity of breastfeeding was maintained despite the early diagnosis of ankyloglossia. Growth indicators were not affected in the sixth month in any of the babies, with only one measuring below expectations in the third month, with no impact on general health. CONCLUSIONS In the cases reported in this paper, the infants overcame the initial difficulties in breastfeeding and maintained their normal growth course in the first 6 months of life.
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Affiliation(s)
- Christyann Lima Campos Batista
- Human Milk Bank, University Hospital, Federal University of Maranhão, Rua Silva Jardim, 215, São Luís, Maranhão, CEP: 65020-560, Brazil.
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Fraga MDRBDA, Barreto KA, Lira TCB, Menezes VAD. Diagnosis of ankyloglossia in newborns: is there any difference related to the screening method? Codas 2021; 33:e20190209. [PMID: 33950147 DOI: 10.1590/2317-1782/20202019209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/25/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To diagnose ankyloglossia in newborns and compare two lingual frenulum assessment instruments. METHODS This cross-sectional study was carried out in Recife, Pernambuco, Brazil, in 2018, with 147 mothers/newborns aged up to 30 days. The Bristol Tongue Assessment Tool and the Lingual Frenulum Evaluation Protocol for Infants were the instruments used. Sociodemographic data were also recorded. The two ankyloglossia diagnostic methods were compared using the McNemar test, obtaining the kappa agreement value and the confidence interval. RESULTS Ankyloglossia was present in 4.8% when diagnosed with the Bristol Tongue Assessment Tool, and in 17.0% with the Tongue-Tie Test. Regarding sex, 53.1% of the newborns were males and 46.9% were females; however, there was no association between ankyloglossia and the newborn's sex in either of the assessment methods. CONCLUSION The ankyloglossia diagnosis in newborns varied depending on the assessment instrument used.
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Affiliation(s)
- Mariana do Rêgo Barros de Andrade Fraga
- Programa de Pós-graduação em Odontologia, Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia - FOP, Universidade de Pernambuco - UPE - Camaragibe (PE), Brasil
| | - Kamila Azoubel Barreto
- Programa de Pós-graduação em Odontologia, Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia - FOP, Universidade de Pernambuco - UPE - Camaragibe (PE), Brasil
| | - Thaís Christine Barbosa Lira
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia - FOP, Universidade de Pernambuco - UPE - Camaragibe (PE), Brasil
| | - Valdenice Aparecida de Menezes
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia - FOP, Universidade de Pernambuco - UPE - Camaragibe (PE), Brasil
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Van Biervliet S, Van Winckel M, Vande Velde S, De Bruyne R, D'Hondt M. Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted. Eur J Pediatr 2020; 179:1191-1195. [PMID: 32506218 DOI: 10.1007/s00431-020-03705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
The frenotomy or surgical release of the lingual frenulum is performed with increasing frequency. Restricted tongue mobility, ankyloglossia, is the main indication for this procedure. This clinical diagnosis is often used as synonym for tongue-tie which is blamed for many feeding difficulties resulting in an increase in performed frenotomies. Until recently, little was known about the anatomical structure and normal variation of the tongue-tie. Different grading systems have been developed. Some are exclusively based on appearance of the tongue-tie; others also include functional elements. There is, however, no established relation between the tongue-tie score and the observed feeding problems or outcomes following frenotomy. Therefore, caution is warranted before submitting babies to this procedure.Conclusion: This narrative review aims to give an overview of current knowledge and concerns regarding the tongue-tie, which need to be considered before referral for a frenotomy. What is Known: • The presence of a tongue-tie is associated with a higher frequency of breastfeeding problems. • Hence, frenotomy is advocated and increasingly performed in infants with breastfeeding problems. Current tongue-tie classifications do not allow to predict breastfeeding problems. What is New: • New anatomy insights caution for possible complications resulting from this seemingly innocent practice of frenotomy. • Frenotomy should only be performed after multidisciplinary evaluation of feeding problems, following exclusion and remediation of other causative factors.
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Affiliation(s)
- Stephanie Van Biervliet
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium.
| | - Myriam Van Winckel
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Saskia Vande Velde
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Ruth De Bruyne
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Marleen D'Hondt
- Paediatric Gastro-enterology and Nutrition, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
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