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Upper Lip Tie and Breastfeeding: A Systematic Review
Rizeq Nakhash1, Natanel Wasserteil1, Francis B Mimouni1,2
11 Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.
Summary
Limited evidence supports routine upper lip tie (ULT) release for infant breastfeeding issues. No randomized controlled trials were found, indicating a need for more research on this common condition.
Area of Science:
- Medical Literature Review
- Lactation and Infant Feeding
Background:
- Upper lip tie (ULT) literature has been indexed since 1998, with related labial frenum articles dating back to 1946.
- Existing research focuses on the relationship between upper lip tie and breastfeeding challenges.
Purpose of the Study:
- To conduct a comprehensive review of the medical literature concerning upper lip tie (or labial frenum/fraenum) and its impact on breastfeeding.
- To assess the quality and quantity of evidence available for upper lip tie interventions.
Main Methods:
- A systematic search of Medline, Google Scholar, and Embase databases was performed for articles published between 1946 and 2018.
- Keywords included "upper lip tie" OR "labial frenum". PRISMA criteria were applied for systematic reviews.
- Articles were categorized by type: case reports, reviews, editorials, cohort studies, non-randomized clinical trials, randomized controlled trials (RCTs), and systematic reviews.
Main Results:
- No randomized controlled trials (RCTs) were identified in the literature.
- The evidence base for the routine surgical release of upper lip tie in infants experiencing breastfeeding difficulties is currently considered poor.
- The reliability of the Kotlow classification system for upper lip tie severity and its correlation with breastfeeding issues was found to be lacking in inter- and intraobserver agreement.
Conclusions:
- There is insufficient high-quality evidence, specifically from RCTs, to support the routine surgical release of upper lip tie for improving infant breastfeeding.
- Further rigorous research is necessary to establish evidence-based guidelines for the diagnosis and management of upper lip tie.
- The clinical utility of existing classification systems for upper lip tie requires further validation.
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