Bundogji Nour, Zamora Steven, Brigger Matthew, Jiang Wen
Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, USA.
Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Surgery, Division of Otolaryngology, University of California San Diego School of Medicine, San Diego, CA, USA.
Int J Pediatr Otorhinolaryngol. 2020 Jun;133:109985. doi: 10.1016/j.ijporl.2020.109985. Epub 2020 Mar 9.
With nationwide effort to increase breastfeeding rates in newborns and infants in recent years, there has been a dramatic increase in the diagnosis of ankyloglossia, and the resultant otolaryngology referral for frenotomy. Overall, there is a paucity of data on the expected benefit of frenotomy in this population and the subsequent breastfeeding rate. The objectives of this study were to assess the effect of office-based frenotomy on improving breastfeeding difficulties among infants with ankyloglossia from a patient-centered perspective and examine associated effects of frenotomy and ankyloglossia type on breastfeeding.
Maternal-infant dyads were referred to a tertiary care otolaryngology practice for assessment of ankyloglossia. A prospective cohort study was conducted in this population from January 2017 to September 2018. Mothers completed questionnaires regarding the quality of breastfeeding before the frenotomy procedure in the office and were subsequently contacted by phone to complete the same questionnaires 1 week and 3 months after the initial encounter. Treating physicians reported ankyloglossia type and expected improvement at the time of the procedure. Descriptive statistics and paired analyses were used to analyze post-frenotomy breastfeeding outcomes and ascertain likelihood of improvement.
During the study period, the mothers of 343 infants agreed to participate in the study by completing the initial questionnaire. Of these infants, 314 (91.5%) underwent frenotomy. Most infants were classified as having either type I (35.3%) or type II (45.2%) ankyloglossia with 16.9% having posterior ankyloglossia and 2.6% with no ankyloglossia. At 1-week post-frenotomy the largest group of patients (35%) had mild improvement in breastfeeding abilities compared to baseline with 14% and 7% reporting moderate or marked improvement respectively. At 3 months after the initial consultation, significantly more patients reported moderate (27%) or marked (17%) improvement when compared to baseline although the exclusively breastfeeding rate at 3 months was low at 20.3% for this cohort.
This prospective study demonstrated that frenotomy had a modestly positive effect on breastfeeding ability from the mother's perspective in infants referred for ankyloglossia. It is important to educate patients on the multi-factorial nature of breastfeeding and to set realistic expectations prior to recommending the procedure.
近年来，随着全国范围内提高新生儿和婴儿母乳喂养率的努力，舌系带过短的诊断率急剧上升，由此导致耳鼻喉科转诊进行舌系带切开术。总体而言，关于该人群舌系带切开术的预期益处及后续母乳喂养率的数据匮乏。本研究的目的是以患者为中心，评估门诊舌系带切开术对改善舌系带过短婴儿母乳喂养困难的效果，并研究舌系带切开术及舌系带过短类型对母乳喂养的相关影响。
母婴二元组被转诊至三级护理耳鼻喉科诊所评估舌系带过短情况。2017年1月至2018年9月在该人群中进行了一项前瞻性队列研究。母亲们在门诊进行舌系带切开术前完成关于母乳喂养质量的问卷，随后在初次就诊后1周和3个月通过电话联系她们完成相同问卷。治疗医生报告手术时的舌系带过短类型及预期改善情况。使用描述性统计和配对分析来分析舌系带切开术后的母乳喂养结果并确定改善的可能性。
在研究期间，343名婴儿的母亲通过完成初始问卷同意参与研究。在这些婴儿中，314名（91.5%）接受了舌系带切开术。大多数婴儿被归类为I型（35.3%）或II型（45.2%）舌系带过短，16.9%为后舌系带过短，2.6%无舌系带过短。舌系带切开术后1周，与基线相比，最大的一组患者（35%）母乳喂养能力有轻度改善，分别有14%和7%报告有中度或显著改善。在初次咨询后3个月，与基线相比，更多患者报告有中度（27%）或显著（17%）改善，尽管该队列3个月时的纯母乳喂养率较低，为20.3%。
这项前瞻性研究表明，从母亲的角度来看，舌系带切开术对因舌系带过短而转诊的婴儿的母乳喂养能力有适度积极影响。在推荐该手术之前，让患者了解母乳喂养的多因素性质并设定现实的期望非常重要。
