Walker Ryan D, Messing Susan, Rosen-Carole Casey, McKenna Benoit Margo
1 Department of Otolaryngology, University of Rochester , Rochester, New York.
2 Department of Biostatistics and Computational Biology, University of Rochester , Rochester, New York.
Breastfeed Med. 2018 Apr;13(3):204-210. doi: 10.1089/bfm.2017.0116. Epub 2018 Mar 20.
The purpose of this study was to investigate the normal lingual frenulum anatomy in newborns and to evaluate tip-frenulum distance as an objective diagnostic tool for identifying newborns at risk for anterior and posterior tongue tie and breastfeeding difficulty.
The distance from the tongue tip to the insertion of the lingual frenulum was measured in a group of 100 healthy newborns to establish normative data. The presence of a visible or palpable cord was noted. Inter-rater reliability was assessed. Breastfeeding surveys including a maternal pain scale and Infant Breastfeeding Assessment Tool (IBFAT) were administered on days of life 2 and 14 to determine whether these findings predict breastfeeding difficulty.
Mean tip-frenulum length was 9.07 mm. Intraclass correlation coefficient between observers for tip-frenulum length was 0.82. A visible cord was identified in 21 subjects (21%). A palpable cord was identified in 59 subjects (59%). Unweighted κ coefficients for inter-rater reliability of visible and palpable cords were 0.91 and 0.47, respectively. Visible cord and shorter tip-frenulum distance were independently predictive of higher maternal pain scores. A positive correlation was identified between tip-frenulum length and IBFAT scores for mothers with two or more previous breastfed children.
Tongue tip-frenulum length correlated with maternal nipple pain, and was useful as an objective tool for identifying newborns at risk for ankyloglossia. Maternal breastfeeding experience appears to be an important factor in the link between tongue anatomy and breastfeeding difficulty. The presence of a palpable cord was variable across examiners, and should be interpreted with caution when evaluating newborns for posterior tongue tie.
本研究旨在调查新生儿舌系带的正常解剖结构，并评估舌尖至系带的距离，作为识别有前后舌系带过短及母乳喂养困难风险新生儿的客观诊断工具。
对100名健康新生儿测量从舌尖到舌系带附着处的距离，以建立规范数据。记录是否存在可见或可触及的条索。评估评分者间信度。在出生第2天和第14天进行母乳喂养调查，包括产妇疼痛量表和婴儿母乳喂养评估工具（IBFAT），以确定这些发现是否能预测母乳喂养困难。
平均舌尖至系带长度为9.07毫米。观察者间舌尖至系带长度的组内相关系数为0.82。21名受试者（21%）发现可见条索。59名受试者（59%）发现可触及条索。可见和可触及条索评分者间信度的未加权κ系数分别为0.91和0.47。可见条索和较短的舌尖至系带距离可独立预测较高的产妇疼痛评分。对于有两个或更多母乳喂养史孩子的母亲，舌尖至系带长度与IBFAT评分呈正相关。
舌尖至系带长度与产妇乳头疼痛相关，可作为识别有舌系带过短风险新生儿的客观工具。产妇的母乳喂养经历似乎是舌部解剖结构与母乳喂养困难之间联系的重要因素。可触及条索的存在在检查者之间存在差异，在评估新生儿后舌系带过短时应谨慎解读。
