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Frenulotomie bij neonatale ankyloglossie en borstvoedingsproblemen : Is anesthesie gewenst?

(2012) Dammen, J.C. (Jara)

Background:
Ankyloglossia is a minor congenital disorder characterized by an abnormally short or thick lingual frenulum which restricts tongue mobility. Mothers of 20-25% of all breastfed neonates with ankyloglossia experience breastfeeding problems, such as poor latch and sore nipples. These complaints contribute to an early switch from breastfeeding to bottle feeding. Breastfeeding is considered to be the golden standard in neonatal nutrition until the age of 6 months. Therefore it is important to signal and – if possible – treat disorders like ankyloglossia, which negatively influence the quality and duration of breastfeeding. Different studies have shown that frenulotomy is a safe and effective procedure to treat ankyloglossia. Nevertheless, significant controversy regarding frenulotomy still exists. A recent study in children aged 0 -18 showed a benefit in the efficacy of frenulotomy, if performed under general anesthesia. The question remains whether this benefit also applies to neonates. In this age group general anesthesia is undesirable, seen the associated risks and the induced treatment delay which may cause early cessation of breastfeeding. Moreover, neonates are easy to stabilize and do not seem to experience a lot of discomfort during the intervention. The aim of this study is to evaluate the safety and outcome of frenulotomy performed without general anesthesia, as well as the impact on neonates during division and parents’ opinion concerning the need of general anesthesia.
Methods:
330 breastfed neonates who underwent frenulotomy in the period 2008 – 2011 were enrolled in this retrospective observational study. All children had been treated in the outpatient clinic, without general anesthesia. One week after frenulotomy, data on complications and effects on breastfeeding were collected by a telephone interview. In April 2012 parents were requested to fill in a questionnaire about the course of frenulotomy, the occurrence of breastfeeding problems before and after the intervention, the eventual duration of breastfeeding, the occurence of problems associated with ankyloglossia at this moment and whether refrenulotomy had been performed.
The Wilcoxon Signed Rank test was used to analyze any change in complaints after frenulotomy. Logistic regression and the backward selection method were used to determine which determinants can predict a lack of improvement.
Results:
One week after frenulotomy 72% of all patients’ parents were interviewed by telephone; 65% of them noticed a positive effect on breastfeeding. 247 (76%) of all questionnaires were returned. 85% of all parents noticed any, strong or complete improvement of breastfeeding complaints. In general, all specific breastfeeding complaints had improved significantly. Children aged older at the time of frenulotomy have a smaller chance that complaints will improve after the procedure. After frenulotomy 54% of all mothers continued breastfeeding for at least three months. Re-frenulotomy was performed in 1 patient (0,4%). No major complications were reported. The impression parents have of the pain their baby experienced during frenulotomy was identical to that during a vaccination. 99,6% of all respondents stated they did not think general anesthesia was necessary. 46% would not have disagreed in performing frenulotomy if general anesthesia was obligatory.
Conclusion:
Frenulotomy without general anesthesia is a safe, effective and minimally aggravating procedure to treat neonatal ankyloglossia associated with breastfeeding problems. In this age group general anesthesia is not necessary and not desirable, considering associated risks, delay in treatment and the opinion of parents whose child underwent frenulotomy.





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