与婴儿束带切开术相关的并发症和误诊：医疗保健专业人员调查结果。
Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey.
机构信息
Department of Pediatrics, Geisel School of Medicine at Dartmouth, and Childrens Hospital at Dartmouth, Hanover, NH, USA.
Kaiser Permanente Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
出版信息
Int Breastfeed J. 2022 May 21;17(1):39. doi: 10.1186/s13006-022-00481-w.
BACKGROUND
In the past 10-15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports.
METHODS
An online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer's V correlation, and binomial logistic regression.
RESULTS
Of 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93).
CONCLUSIONS
Complications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.
背景
在过去的 10-15 年中，人们越来越关注舌系带过紧及其对婴儿母乳喂养的影响。这与实施切舌系带术的增加有关。在母乳喂养方面具有专业知识的医生和其他医疗保健专业人员对与婴儿切舌系带术相关的并发症表示关注。关于这个主题的评论报告在切舌系带术后没有明显的并发症。其他有关并发症的数据包括病例报告。
方法
由具有母乳喂养专业知识的医生开发了一项在线调查，并于 2019 年 11 月 11 日至 12 月 31 日期间发送给母乳喂养医学学会（ABM）的医生和牙医成员。它要求照顾母婴母乳喂养夫妇的受访者提供有关他们个人照顾与 referral 相关的婴儿的经验的信息接受切舌系带术或进行切舌系带术的并发症或误诊。使用卡方检验、Cramer's V 相关系数和二项逻辑回归对数据进行了分析。
结果
在 211 名合格的受访者中，有 129 名（61%）照顾过有并发症或误诊的婴儿。报告了 209 名婴儿有并发症，237 名婴儿有误诊。报告的最常见误诊是 237 名婴儿中有 101 名（43%）有神经肌肉功能障碍和 65 名（27%）有母乳喂养支持不足。报告的最常见并发症是重复手术被认为/要求/进行 65 次（32%）和口腔厌恶 57 次（28%）。父母报告婴儿疼痛与进行后切舌系带术（卡方检验 p < 0.003）相关。出血与使用剪刀/手术刀与激光/电烙术/电凝术（卡方检验 p = 0.001）相关。口腔厌恶与使用激光/电烙术/电凝术进行切舌系带术（调整后的优势比为 4.05；95%CI 2.07，7.93）相关。
结论
婴儿切舌系带术后会发生并发症和误诊。医生和牙医应与哺乳专家密切合作，提供熟练的母乳喂养支持，并在 referral 进行切舌系带术之前评估可能影响婴儿母乳喂养的其他混杂问题。需要对优化的母乳喂养支持与切舌系带术、剪刀与激光在切舌系带术中的应用进行随机对照试验。
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