137 - The efficacy of the Picture assessment tool for tongue-tie in breastfed babies (TABBY) in evaluating the need for treatment: a LINgual frenulum in NEwborn infants (LINNE) -project pilot study

Poster Number: 137
Publication Number: 137.1808

Background: Neonatal tongue-tie is a common anatomic variant that may restrict tongue movements and complicate breastfeeding. Its treatment, most often frenotomy, reduced breastfeeding difficulties. However, 50% of tight-looking frenulums never caused breastfeeding problems. Due to lack of an established tool, newborn patient selection for frenotomy remains a challenge. The TABBY tool has been developed as an objective score of tongue-tie severity for healthcare professionals’ use (Ingram 2019).

Objective: To study the diagnostic efficacy and usability of the TABBY tool in newborns’ need for tongue-tie treatments and breastfeeding difficulties.

Design/Methods: In the present, ongoing LINNE-project, healthy, full-term neonates have been recruited to an observational study for early diagnosis of tongue-tie, and when indicated, to a randomized clinical trial (RCT) of its therapies, in Oulu University Hospital, Oulu, Finland, from Oct 3, 2022. All parents gave informed written consent. Exclusion criteria are prematurity, major anomalies, serious illness of the newborn/mother, a non-breastfeeding mother, and non-Finnish-speaking caregivers. TABBY tool was chosen for scoring of the infant oral structures, to diagnose a severe tongue-tie and, in comparison, breastfeeding problems. TABBY tests were performed by trained study physicians and peer-educated ward midwives who were mutually blinded. Receiver operator curves (ROC) with area under curve (AUC) were used for analyses of diagnostic efficacy of pre-specified TABBY elements and total scorings. To analyze the variability in diagnostic accuracy of TABBY scorings’ between 2 independent assessors, we used the multi-rater Fleiss kappa (k) analysis. The subjective usability of TABBY was inquired by an opinion poll.

Results: Present pilot observational study was completed on Sep 29, 2023. 556 consecutive participants had been studied for breastfeeding problems and their oral structures double-assessed with TABBY tool (Table). Its efficacy in diagnosing (AUC; Figure) the need for tongue-tie therapy by physicians (n=5) was 0.948 (95%CI 0.924-0.973) and by midwives (n=82) 0.870 (95%CI 0.830-0.911). It showed limited value in breastfeeding problems. The total TABBY scorings’ agreement was k=0.441 (95%CI 0.406-0.477). Favorable user opinions were received in 5 (100%) of physicians and 30 (37%) of midwives.

Conclusion(s): Physicians and midwives detected the tongue-ties needing treatment, using the TABBY tool. Its diagnostic efficacy was lower in breastfeeding problems, as expected. TABBY tool was simple to use to healthcare professionals’ opinions.
231031_TABLE_TABBYJPEG.1.jpeg

231031_Abstrakti_TABBYFIG.1.jpeg