Bronwyn Dixon1, Juliet Gray2, Nikki Elliot3, Brett Shand4, Adrienne Lynn5. 1. Neonatal Department, Christchurch Women's Hospital, Christchurch, New Zealand. Electronic address: Bronwyn.dixon@cdhb.health.nz. 2. Hospital Dental Service, Christchurch Hospital, Christchurch, New Zealand. Electronic address: Juliet.graydentist@cdhb.health.nz. 3. Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand. Electronic address: Nikki.elliot@cdhb.health.nz. 4. Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand. Electronic address: Brett.shand@cdhb.health.nz. 5. Neonatal Department, Christchurch Women's Hospital, Christchurch, New Zealand. Electronic address: Adrienne.lynn@cdhb.health.nz.
Abstract
OBJECTIVES: A programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided. METHODS: Local healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function using a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public. RESULTS: Frenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support. CONCLUSIONS: Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.
OBJECTIVES: A programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided. METHODS: Local healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function using a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public. RESULTS: Frenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support. CONCLUSIONS: Establishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.
Authors: Raymond J So; Carolyn Jenks; Marisa A Ryan; David E Tunkel; Margo K McKenna Benoit; Jonathan M Walsh Journal: Laryngoscope Investig Otolaryngol Date: 2022-08-19
Authors: María Del Puerto González Garrido; Cristina Garcia-Munoz; Manuel Rodríguez-Huguet; Francisco Javier Martin-Vega; Gloria Gonzalez-Medina; Maria Jesus Vinolo-Gil Journal: Int J Environ Res Public Health Date: 2022-09-28 Impact factor: 4.614