Impacto das alterações do frênulo lingual na qualidade e continuidade do aleitamento materno exclusivo

Abstract

Objective: To analyze the association between the presence of ankyloglossia with the quality of exclusive breastfeeding in the immediate postpartum period and its continuity at three and six months after hospital discharge. Method: This is a longitudinal study, carried out with 149 babies from a Brazilian public maternity hospital. During the postpartum period, sociodemographic, obstetric and neonatal clinical data were compiled to characterize the sample. In addition, a questionnaire designed specifically for the research was applied to mothers in order to investigate the presence of self-reported breastfeeding difficulties. Newborns were assessed for the lingual frenulum function using two specific protocols, the Neonatal Tongue Screening Test (NTST) and the Bristol Tongue Assessment Tool (BTAT). They were also submitted to breastfeeding assessment using the LATCH instrument, adapted and validated for Brazilian Portuguese. In the prospective stage, the binomials were contacted via phone or e-mail at three and six months after hospital discharge, in order to compile data regarding the continuation of exclusive breastfeeding and associated information. For this stage, a structured interview was also prepared containing questions related to the type of baby’s feeding, the moment of interruption of breastfeeding in cases of weaning and the reason for doing so, as well as the presence of harmful oral habits and the moment of introduction of complementary feeding. Descriptive analyzes were carried out using frequency distribution for categorical variables and measures of central tendency and dispersion for continuous variables. To investigate the association between explanatory variables and breastfeeding performance while the binomial was still in the hospital, the Mann-Whitney and Kruskal-Wallis tests were used, with results with p <0.05 being considered significant. The correlation between both instruments for lingual frenulum evaluation was tested using the Kappa Coefficient. To analyze breastfeeding follow-up data, the Chi-squared test was used to investigate which variables were associated with breastfeeding interruption. Those with a p-value <0.20 were also submitted to multivariate analysis through logistic regression. Results: The prevalence of ankyloglossia was 2.7% by the NTST and 3.4% by the BTAT. There was a high and significant agreement between the two instruments used for the diagnosis (Kappa = 0.885). It was not possible to establish an association between ankyloglossia and breastfeeding difficulties diagnosed by the LATCH instrument, but there was an association between primiparity (p = 0.022), self-reported breastfeeding difficulties (p = 0.001) and breastfeeding problems detected in the professional assessment using LATCH. Regarding breastfeeding follow-up, the main factors related to its discontinuation were low maternal educational level (p = 0.049) and the presence of harmful oral habits (p <0.001). Conclusion: The prevalence of ankyloglossia in the present study was low and there was a high and significant agreement between the two instruments used for diagnosis. It was not possible to establish a relationship between ankyloglossia and the establishment or even the discontinuation of exclusive breastfeeding. The main causes related to the interruption of breastfeeding were low maternal educational level and the presence of harmful oral habits.