title: The outcomes of a frenulotomy on breastfeeding infants followed up for 3 months at Thammasat University Hospital.
abstract: OBJECTIVE
  To study the effects of frenulotomy on nipple pain, latch and the success in exclusive breastfeeding (EBF) at 3-month follow-up.
  
  
  METHODS
  A prospective cross-sectional study of 328 mother-infant pairs with both tongue-tie and breastfeeding problems was performed. Nipple pain and latch were evaluated using numeric rating scale and LATCH score, respectively, and compared between pre and post-operatively at 24 h and 1 week. The success rate of EBF was assessed at 3 months after frenulotomy.
  
  
  RESULTS
  Nipple pain score were significantly decreased (median difference = 3 and 4, P < 0.001) and LATCH score were significantly increased (mean difference = 1.92 and 2.13, P < 0.001) at 24 h and 1 week post-operatively. At 3 months, a success rate of EBF was 66.67 %. Multivariable analysis clustering by maternal age of 18 years was performed. Factors that were significantly (P < 0.05) associated with the success were: girls, age at surgery ≤24 h, higher number of children in family, low birth weight, tongue-tie severity, nipple grading, LATCH score ≥8 and nipple sensation at 1 week after surgery.
  
  
  CONCLUSIONS
  Frenulotomy could significantly reduce nipple pain and increase LATCH score in tongue-tied infants with breastfeeding difficulty. Several factors are positively associated with the success of EBF. Tongue-tie severity, LATCH score and nipple sensation were the factors that can be modified by frenulotomy.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Thammasat University Hospital, 95/8, Khlongnueng Sub-district, Khlongluang District, Pathumthani Province, 12120, Thailand. j_wakhanrittee@hotmail.com.
authors.forename: Junsujee
authors.initials: J
authors.lastname: Wakhanrittee
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Jiraporn
authors.initials: J
authors.lastname: Khorana
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Thammasat University Hospital, 95/8, Khlongnueng Sub-district, Khlongluang District, Pathumthani Province, 12120, Thailand.
authors.forename: Siriphut
authors.initials: S
authors.lastname: Kiatipunsodsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000072676:Ankyloglossia / Q000150:complications / Q000601:surgery*; D001942:Breast Feeding / Q000379:methods / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008035:Lingual Frenum / Q000601:surgery*; D008297:Male; D009035:Mothers; D009558:Nipples; D010146:Pain / Q000209:etiology; D011446:Prospective Studies; D013785:Thailand; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breastfeeding success rate; Exclusive breastfeeding; Frenulotomy; Tongue-tie