Surgeries to help newborns nurse may have become too common

(Reuters Health) – Minor surgery to help newborns latch on and nurse may have become too common, a new study suggests.

More than 60% of babies referred to a specialty center for tongue-tie surgery, or frenotomy, did not need the operation, researchers report in JAMA Otolaryngology – Head & Neck Surgery.

Sometimes the procedure is truly needed, study coauthor Dr. Christopher Hartnick told Reuters Health.

“But we were struck by how these procedures were becoming more and more common,” said Hartnick, a professor at the Harvard Medical School and director of the Pediatric Airway, Voice and Swallowing Center at the Massachusetts Eye and Ear Infirmary in Boston. “When a newborn is having trouble feeding, you have to start asking questions as to why and whether there is a feeding disorder and if there are strategies that can help avoid surgery.”

In children referred for tongue-tie surgery, a tissue called the lingual frenulum connects the tongue too tightly to the floor of the mouth, restricting the tongue’s movement. A different procedure, called lip tether surgery, is sometimes done when the frenulum of the upper lip connects it too tightly to the gums.

“The newborn’s task is to breathe and feed,” Hartnick said. “To feed they need to form a seal with their mouths around the nipple of the mother or a bottle. If the upper lip doesn’t form the seal because it’s tied too tight to the gum line or the tongue is tied too tight to the floor of the mouth, the baby has an anatomic reason for having trouble feeding. Releasing those little tethers allows the lip to come forward or the tongue to move.”

Often, however, there are a combination of factors getting in the way of nursing, Hartnick said.

“While our study is small, it casts light on the fact that more and more parents who have just given birth are being told their child needs a surgical procedure for which there is not an enormous amount of outcome data on how often it works and what are the risks and what are other possible interventions,” he said. “And the number being done has skyrocketed over the last five or 10 years.”

In fact, an analysis of the Kids’ Inpatient Database in the United States found a 10-fold increase in tongue-tie surgeries between 1997 and 2012, Hartnick and colleagues noted. Prompted by those rising rates, they formed a multidisciplinary feeding evaluation program at their center. Each mother-newborn pair met with a pediatric speech-language pathologist who evaluated breast feeding issues and then offered feedback and strategies to help.

For the new study, Hartnick’s team examined the records of 115 newborns referred for tongue-tie surgery who underwent evaluation by the multidisciplinary team. The team concluded that 62.6% of the babies did not need surgery to fix breastfeeding issues.

Hartnick advises parents who are told their baby needs tongue-tie surgery or lip-tether surgery to ask questions. “They may feel uncomfortable asking questions and some newborns may need a procedure but it’s best to arm yourself with the facts,” he said.

The new study emphasizes the need to look at all the options when a newborn is having trouble breastfeeding, said Dr. Jonathan Walsh, an assistant professor of otolaryngology at Johns Hopkins University School of Medicine in Baltimore.

“When a diagnosis of tongue tie comes up in the setting of breastfeeding difficulty, it helps to have a sense that the provider is critically analyzing things and is taking the time to consider all the options,” said Walsh, who was not involved in the new research.

“In the context of the exponential growth of these procedures, studies like this one help us, as a medical community and society, to cautiously put the brakes on,” Walsh said. “While in general these surgeries are very safe and have a very low rate of complications, it’s not zero. You can have severe bleeding, infections and injuries to the saliva ducts.”

SOURCE: JAMA Otolaryngology – Head & Neck Surgery, online July 11, 2019.

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