Article Figures & Data
Figures
- FIGURE 1
Disposition of articles identified by the search strategy. aIncludes data from 1 unpublished thesis. bNumbers do not tally, as studies could be excluded for multiple reasons.
Tables
Category Criteria Study population Inclusion: Children ages 0–18 with ankyloglossia or ankyloglossia with concomitant tight labial frenulum (lip-tie); Exclusion: Studies with participants with Van der Woude syndrome, Pierre Robin syndrome, Down syndrome, or craniofacial abnormalities were excluded, as were studies of premature infants (<37 wk of gestation60) Publication languages Inclusion: English Exclusion: Non-English Admissible evidence (study design and other criteria) Included study designs: RCTs, prospective and retrospective cohort studies, nonrandomized controlled trials, prospective and retrospective case series, and crossover studies Case reports to assess harms Other criteria: Original research studies providing sufficient detail regarding methods and results to enable use and aggregation of the data and results Studies must address 1 or more of the following: • Surgical interventions (simple anterior frenectomy, laser frenulectomy, posterior frenulectomy, Z-plasty repair) • Nonsurgical treatments include complementary and alternative medicine (CAM) therapies (eg, craniosacral therapy, myofascial release, and other chiropractic therapies), lactation intervention, speech therapy, physical therapy, oral motor therapy, and stretching exercises/therapy • Baseline and outcome data (including harms) related to interventions for ankyloglossia Relevant outcomes must be able to be extracted from data in the papers Data must be presented in the aggregate (versus individual participant data) Grade Definition High We are very confident that the estimate of effect lies close to the true effect for this outcome:. The body of evidence has few or no deficiencies. We believe that the findings are stable (ie, another study would not change the conclusions). Moderate We are moderately confident that the estimate of effect lies close to the true effect for this outcome. The body of evidence has some deficiencies. We believe that the findings are likely to be stable, but some doubt remains. Low We have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both). We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect. Insufficient We have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome. No evidence is available or the body of evidence has unacceptable deficiencies, precluding reaching a conclusion. Excerpted from Berkman et al.6
Study Age, d (IQR, Range, Mean, or Mean ± SD) Baseline Measures Outcomes at 5 d Outcomes at 8 wk Study Design/Setting Groups, n Enrollment/n Final Quality LATCH Emond et al 20139 Mean at 5 d follow-up (IQR) G1+G2: ≤ 8 Median (IQR) Median (IQR) RCT/Hospital clinic G1: 11 (8–14) G1: 9 (8–10) G1: 10 (10–10) G1: Frenotomy, 55/52 G2: 11 (8–16) G2: 9 (8–10) G2: 10 (10–10) G2: Usual care, 52/50 G1 vs. G2: P = 1.0 G1 vs. G2: P = .41 Quality: Good Dollberg et al 200611 Range of days Mean ± SD. Mean ± SD. NA RCT G1+G2: 1–21 G1+G2: 6.4±2.3 G1+ G2: 6.8±2.0 G1: Frenotomy, breastfeeding/ sham, breastfeeding, 15/14 P = .06 compared with baseline G2: Sham, breastfeeding, frenotomy, breastfeeding, 11/11 Quality: Poor BSES-SF Emond et al 20139 Mean at 5 d follow-up (IQR) NR Median (IQR) Median (IQR) RCT/Hospital clinic G1: 11 (8–14) G1: 54 (43–62) G1: 63 (59–68) G1: Frenotomy, 55/52 G2: 11 (8–16) G2: 53 (40.8–61) G2: 63 (57–69) G2: Usual care, 52/50 G1 vs. G2: P = .53 G1 vs. G2: P = .62 Quality: Fair IBFAT Emond et al 20139 Mean at 5 d follow-up (IQR) NR Median (IQR) Median (IQR) RCT/Hospital clinic G1: 11 (8–14) G1: 12 (11–12) G1: 12 (12–12) G1: Frenotomy, 55/52 G2: 11 (8–16) G2: 12 (11–12) G2: 12 (12–12) G2: Usual care, 52/50 G1 vs. G2: P = .76 G1 vs G2: P = .58 Quality: Good Buryk et al 20117 Mean days ± SD at enrollment IBFAT, mean ± SE. Immediately after procedure, mean ± SE. NA RCT/Newborn nursery or clinic, otolaryngology clinic G1: 6.2 ± 6.9 G1: 9.3 ± 0.69 G1: 11.6 ± 0.81 G1: Frenotomy, 30 G2: 6.0 ± 7.0 G2: 8.5 ± 0.73 G2: 8.07 ± 0.86 G2: Sham procedure, 28 G1 vs G2, P = .029 Quality: Good Effect size: 0.31 Not all RCTs reported these measures. BSES-SF, Breastfeeding Self-Efficacy Scale-Short Form; G, group; NA, not applicable; NR, not reported.
Study Age, d Baseline Measures, Mean ± SD Follow-up Measures Study Design/Setting Groups, n Enrollment/n Final Quality Visual Analog Scale Emond et al 20139 Mean at 5-d follow-up (IQR) NR 5 d, median (IQR) RCT/Hospital clinic G1: 11 (8–14) G1: 3 (1–4.3) G1: Frenotomy, 55/52 G2: 11 (8–16) G2: 3 (2–6) G2: Usual care, 52/50 G1 vs. G2: P = .13 Quality: Good 8 wk, median (IQR) G1: 0 (0) G2: 0 (0–1) G1 vs. G2: P = .41 Berry et al 20128 Mean (range) G1: 4.1 ± NR Mean immediately after procedure RCT/Hospital (not specified) G1: 33 (6–115) G2: 4.2 ± NR G1: 1.6 G1: tongue-tie division, 30/27 G2: 28 (5–111) G2: 2.9 G2: sham procedure, 30/3 Mean change ± SD: Quality: Good G1: –2.5 ± 1.9 G2: –1.3 ± 1.5, P = .13 (95% CI: –0.3–2.4) Short-Form McGill Pain Questionnaire Buryk et al 20117 Mean ± SD at enrollment G1: 16.8 ± 10.6 Mean ± SD immediately after procedure RCT/Newborn nursery or clinic, otolaryngology clinic G1: 6.2 ± 6.9 G2: 19.2 ± 9.9 G1: 4.9 ± 1.46 G1: Frenotomy, 30 G2: 6.0 ± 7.0 G2: 13.5 ± 1.5 G2: Sham procedure, 28 G1 vs G2: P < .001 Quality: Good Effect size: 0.38 G, group; NR, not reported.
Measure Description Breastfeeding Effectiveness Breastfeeding Self-Efficacy Scale (BSES) Measure of maternal breastfeeding confidence that uses a 5-point (1 = not at all confident to 5 = always confident) Likert scale to assess agreement with statements such as “I can always position my infant correctly at my breast.” BSES scores range from 33–165 on the 33-item instrument and 14–70 on the 14-item BSES-Short Form. Higher overall scores indicate higher levels of breastfeeding self-efficacy. Infant Breastfeeding Assessment Tool (IBFAT) Measure of clinician or maternally rated perception of 4 items related to effectiveness of and satisfaction with a feeding (readiness to feed, rooting, latching on, sucking) rated on a 3-point scale (eg, 3 = rooted effectively at once, 0 = did not root). Higher scores indicate greater perceived effectiveness. IBFAT scores range from 0–12; 12 = vigorous and effective feeding. Latch, Audible swallowing, Type of nipple, Comfort, Hold (LATCH) Measure of effectiveness of latch to the breast, feeding, comfort for mother, and maternal positioning rated on 3 levels with higher scores indicating greater effectiveness. LATCH score ≤8 = breastfeeding difficulties. See Baghurst et al 2007, Pollard et al 2009, Matthews 1988, and Jensen et al 1994 for a complete description of the tools in the full review at http://www.effectivehealthcare.ahrq.gov.
In this issue
Treatment of Ankyloglossia and Breastfeeding Outcomes: A Systematic Review
