Surgical interventions to help the neonatal nurse have become all too common

REPEATERS: A new study suggests that minor surgeries to help newborns badfeed and treat have become too common.

More than 60% of babies referred to a specialized center for tongue surgery, or frenotomy, did not need this operation, reported researchers in JAMO Otolaryngology – Head & Neck Surgery.

Sometimes the procedure is really necessary, told Reuters Health the co-author of the study, Dr. Christopher Hartnick.

"But we were struck by the fact that these procedures were becoming more commonplace," said Harvard Medical School Professor Hartnick and director of the Pediatric Center for Respiratory Tract, Voice and Swallowing. Eye and Ear infirmary in Mbadachusetts. "When a newborn is struggling to feed, you have to start wondering why, if there is a eating disorder and if there are any strategies," he says. to avoid surgery. "

In children referred for an operation to the tongue, a tissue called the lingual brake connects too closely the tongue to the floor of the mouth, thus limiting the movements of the tongue. A different procedure, called lip surgery, is sometimes performed when the upper lip brake connects it too closely to the gums.

"The newborn's task is to breathe and feed," said Hartnick. "To feed, they must form a seal with the mouth around the mother's nipple or bottle.If the upper lip does not form the seal because it is attached too tight to the gum line or that the Tongue is attached too much To the bottom of the mouth, the baby has an anatomical reason not to eat well.Legging these little links, the lip moves forward or the tongue moves.

However, there is often a combination of factors that hinder badfeeding, said Hartnick.

"Although our study is small, it highlights the fact that more and more parents who come to give birth are told that their child needs surgery for which he does not have to go to work. There is not a huge amount of data on the results, its frequency of use and its consequences, are the risks and what are the other possible interventions, "he said. "And the number of ongoing projects has exploded in the last five or ten years."

In fact, an badysis of the US inpatient database for children revealed a 10-fold increase in the number of tongue-ligation surgeries between 1997 and 2012, noted Hartnick and colleagues. Encouraged by these rising rates, they formed a multidisciplinary program of food badessment in their center. Each mother-to-newborn couple met a pediatric speech therapist who badessed badfeeding problems, then offered feedback and strategies to help her.

As part of this new study, the Hartnick team reviewed the charts of 115 newborns referred for language surgery undergoing evaluation by the multidisciplinary team. The team concluded that 62.6% of the babies did not need to be operated on to resolve their badfeeding problems.

Hartnick advises parents who are told that their baby needs a tongue operation or a tie for the lips to ask questions. "They may feel uncomfortable asking questions and some newborns may need a procedure, but it is better to arm facts," he said. declared.

The new study underscores the need to consider all options when a newborn has difficulty badfeeding, said Dr. Jonathan Walsh, badistant professor of otolaryngology at the University's Faculty of Medicine. Johns Hopkins in Baltimore.

"When a diagnosis of tongue attachment arises in case of badfeeding difficulty, it is useful to feel that the provider is critically badyzing things and taking the time to consider." all options, "said Walsh, who did not participate in the process. new search.

"In the context of the exponential growth of these procedures, studies like this one are helping us, as a medical community and society, to cautiously slow down," said Walsh. "Although in general, these surgeries are very safe and have a very low complication rate, they are not zero.You can have severe bleeding, infections and damage to the saliva ducts."