The quality of evidence is downgraded by study limitations (lack of blinding), and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 5 studies with a total of 302 healthy term infants with moderate or severe tongue-tie and feeding difficulties and/or whose mothers were experiencing nipple pain. The studies compared frenotomy versus no frenotomy or frenotomy versus sham procedure. Three studies objectively measured infant breastfeeding. Pooled analysis showed no change on a 10-point feeding scale following frenotomy (MD -0.1, 95% CI -0.6 to 0.5 units; 2 studies, n=155). A third study (n = 58) showed objective improvement on a 12-point feeding scale (MD 3.5, 95% CI 3.1 to 4.0 units of a 12-point feeding scale). Four studies objectively assessed maternal pain. Pooled analysis based on a 10-point pain scale showed a reduction in maternal pain scores following frenotomy (MD -0.7, 95% CI -1.4 to -0.1 units; 3 studies, n=212). A fourth study (n = 58) also showed a reduction in pain scores on a 50-point pain scale (MD -8.6, 95% CI -9.4 to -7.8 units). All studies reported no adverse effects following frenotomy.
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