P0326 - Exclusive Breastfeeding Outcomes after Early Sublingual Frenotomy

Background: Ankyloglossia is considered one reason for breastfeeding difficulty and early breastfeeding cessation. Reported benefits of sublingual frenotomy include improved latch, reduced maternal nipple pain and maintained breastfeeding. Little is known about the benefits of frenotomy during the birth hospitalization and whether early sublingual frenotomy impacts the duration of breastfeeding. We aim to explore the relationship between early sublingual frenotomy and breastfeeding in the first six months of life.

Methodology: This is a retrospective observational analysis on infants born at a public hospital who were admitted to the Newborn Nursery. Any infant admitted to the NICU during birth hospitalization was excluded. Data was collected from electronic medical records.

Results: Data was collected from 508 infants. The mean gestational age was 38.5 weeks (SD 1.447) and the mean birth weight was 3291 g (SD 464). A frenulum was documented in 252 infants. Of these infants, 57% had feeding difficulty compared with 37% of infants without a frenulum. A sublingual frenotomy was performed during birth hospitalization on 19.8% of infants and in clinic on 8.7% of infants. Mean day of life on which the frenotomy was performed was 3.5 (SD 4.05). Of the infants undergoing frenotomy, 75% had a frenulum of at least 30% obstruction. Infants who underwent frenotomy during birth hospitalization had the highest rates of exclusive breastfeeding and 98.6% were being offered some breast milk. At the two-week visit, infants who received frenotomy were exclusively breastfeeding at a higher rate than those who did not. This effect seemed to wane by the two-month visit, at which time both groups of infants were exclusively breastfeeding at similar rates. At the four and six-month visits, exclusive breastfeeding rates remained around 30% for both infants who underwent frenotomy and those who did not.

Discussion: For infants with a documented frenulum and feeding difficulty during the birth hospitalization, a frenotomy early in life may initially improve exclusive breastfeeding. This trend did not continue through the first six months of life. There is a large decrease in exclusive breastfeeding between the two-week and two-month visits in infants who underwent a sublingual frenotomy, at which point rates of exclusive breastfeeding were similar for all infants, regardless of whether they underwent frenotomy.

Conclusion: The benefit of early frenotomy appeared to wane over time, and ongoing lactation support may be beneficial to sustain exclusive breastfeeding. A limitation of this analysis is unknown feeding outcomes for patients lost to follow up. Future investigations and interventions will explore why infants transition to formula feeding prior to the two-month visit and provide more intensive breastfeeding support for mothers who desire to continue exclusive breastfeeding.