Frenotomy in Infants with Tongue-Tie and Breastfeeding Problems.

BACKGROUND: Infant tongue-tie can cause breastfeeding problems, which may be improved by frenotomy. However, controversy exists among the medical community. RESEARCH AIM: To examine the influence of frenotomy on infants with posterior ankyloglossia, by quantifying the changes in breastfeeding and maternal nipple pain using standardized tools. METHODS: Newborns (N = 30) below 12 weeks of age were recruited from the Herzl-Goldfarb Breastfeeding Clinic between April 2014 and April 2015. Diagnosis of posterior ankyloglossia was made clinically. Frenotomy was performed. Mothers received breastfeeding counseling before and after the procedure. Pain and breastfeeding were assessed before the procedure, immediately after the procedure, and after 2 days, 7 days and 14 days. Breastfeeding was assessed using the LATCH Tool and by subjective questioning. Maternal nipple pain was assessed using the Numeric Rating System. RESULTS: No complications were reported with frenotomy. There was a significant improvement in LATCH score immediately post-frenotomy, with an increase in median scores from 7.5 to 8.5 (p < .0001, Wilcoxon signed rank test). There was a significant decrease in median pain score immediately post-frenotomy, from 3.0 on the left nipple and 3.25 on the right nipple, to 0 bilaterally (p < .0001, Wilcoxon signed rank test). Subjective improvement in breastfeeding was reported by 90% of mothers immediately after frenotomy and 83% of mothers at Day 14. CONCLUSION: Frenotomy for posterior ankyloglossia may improve breastfeeding and nipple pain.

Effectiveness of a 3-hour breastfeeding course for family physicians.

OBJECTIVE: To test the effectiveness of a 3-hour course on breastfeeding for family physicians. DESIGN: A previously validated questionnaire testing confidence in, attitudes toward, and knowledge of breastfeeding issues was administered to participants 1 week before and 2 months after taking the Breastfeeding Basics for the Practicing Physician course. SETTING: Canada. PARTICIPANTS: Family physicians and residents who attended the Breastfeeding Basics for the Practicing Physician course between July 2008 and December 2010. INTERVENTIONS: Participants' scores on the questionnaires that were filled out before and after the course were collected and analyzed.

Four true umbilical cord knots.

BACKGROUND: True umbilical cord knots are rare, but may be associated with intrapartum fetal distress and perinatal complications. CASE: This report describes a pregnancy complicated by intrauterine growth restriction and oligohydramnios. The labour was complicated by a non-reassuring fetal heart rate tracing. Four umbilical cord knots were discovered at the time of delivery. The baby's neonatal course was uncomplicated. CONCLUSION: There is currently no reliable method of detecting umbilical cord knots using ultrasound or colour Doppler flow studies. Cord knots may be responsible for fetal compromise during labour and delivery.

Ankyloglossia in breastfeeding infants: the effect of frenotomy on maternal nipple pain and latch.

OBJECTIVE: The aim of this study was to measure the effectiveness of frenotomy in ankyloglossic infants, by quantifying the changes in latch and maternal nipple pain using standardized tools. METHODOLOGY: Infants below 12 weeks of age were recruited from the Goldfarb Breastfeeding Program between August 2004 and February 2005. Infants were selected based on the Frenotomy Decision Rule for Breastfeeding Infants (FDRBI), a new clinical tool for future validation. Latch was assessed using the Latch Tool. Maternal nipple pain was assessed using R. Melzack's Short Form McGill Pain Questionnaire, consisting of the Pain Rating Index (PRI) and Present Pain Intensity (PPI). Frenotomy was performed, followed by repeat latch and pain assessments. Mothers also received breastfeeding counseling throughout and after the procedure. A telephone questionnaire was administered 3 months later. RESULTS: Twenty-seven (27) mother-infant dyads participated in the study. No complications were seen with frenotomy. All infants had an equal or higher latch score after frenotomy, with an improvement in mean latch score of 2.5 (p < 0.0001, 95% confidence interval [CI], 2.038, 2.925). Maternal pain scores decreased significantly after frenotomy, with mean improvements of -11.4 points (p < 0.0001, 95% CI, -15.544, -7.345) on the PRI subscale and -1.5 points (p < 0.0001, 95% CI, -1.952, -1.011) on the PPI subscale. Seventy-seven point eight percent (77.8%) of subjects were still breastfeeding after 3 months; 92% were pain free after 3 months; and 88% felt the frenotomy had helped them. CONCLUSION: Timely frenotomy and breastfeeding counseling is an effective intervention, improving latch and decreasing nipple pain.