Emond A, Ingram J, Johnson D, et al. Randomised controlled trial of early
frenotomy in breastfed infants with mild-moderate tongue-tie. Arch Dis Child
Fetal Neonatal Ed. 2013 Nov 18. doi: 10.1136/archdischild-2013-305031.
(Original) PMID: 24249695

Pediatric Neonatology                   

 

Abstract

TRIAL DESIGN: A randomised, parallel group, pragmatic trial.

SETTING: A large UK maternity hospital.

PARTICIPANTS: Term infants <2 weeks old with a mild or moderate degree of
tongue-tie, and their mothers who were having difficulties breastfeeding.

OBJECTIVES: To determine if immediate frenotomy was better than standard
breastfeeding support.

INTERVENTIONS: Participants were randomised to an early frenotomy
intervention group or a `standard care` comparison group.

OUTCOMES: Primary 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.

RESULTS: 107 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.

CONCLUSIONS: Early 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.

 

Comments from Clinical Raters

Pediatric Neonatology

 

    A well-conducted study that shows that frenotomy improves maternal
self-efficacy on breast-feeding and reduces switching to bottle on day 5
despite failing to show a difference in objective rating on the
effectiveness of breast feeding. This shows the limitation of any objective
scoring such as the LATCH scores in assessing breast feeding effectiveness
compared to mothers' own perception, as pointed out by the authors. Perhaps
future studies should determine which infant with tongue-tie would benefit
from early frenotomy based on maternal perception of the efficacy of
breast-feeding. 

 

Pediatrics (General)

 

    Tongue-tie is a frequent problem in pediatric offices. It worries
mothers especially when they have difficulties breastfeeding. This study
does not support early tongue-tie release in its mild and moderate forms to
improve breast feeding success. It confirms my practice experience
suggesting that "a wait and see approach" takes care of most maternal
breastfeeding worries and frenotomy is only indicated in its more severe
forms.



---
This email is free from viruses and malware because avast! Antivirus protection is active.
http://www.avast.com

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome