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. 2023 Nov 10;36(2):e20230054.
doi: 10.1590/2317-1782/20232023054. eCollection 2023.

Dysfunctional suction dynamics in newborns with ankyloglossia

Bruna Mendes Lourenço Cunha  1 , Erika Baptista Luiz Badarane  1 , Paulo Vitor Melo Sousa Filho  1 , Kauê Machado Costa  2 , Manoel da Silva Filho  1
Affiliations

Dysfunctional suction dynamics in newborns with ankyloglossia

Bruna Mendes Lourenço Cunha et al. Codas. .

Abstract
in English, Portuguese

Purpose: Compare infant suction in babies with and without ankyloglossia using a microprocessor-controlled pressure sensor coupled to a pacifier.

Methods: Fifty-five infants from 0 to 2 months of age underwent clinical examination for ankyloglossia, after which they were offered a silicone pacifier connected to the pressure acquisitiondevice and suction activity was recorded. Thus, we extracted the frequency of sucks within a burst, the average suck duration, the burst duration, the number of sucks per burst, the maximum amplitude of sucks per burst and the inter-burst interval.

Results: The key difference in newborns with ankyloglossia in relation to control was that they perform longer bursts of suction activity.

Conclusion: The longer burst durations are likely a compensatory strategy and may underlie the pain reported by mothers during breastfeeding. We therefore propose a method for objectively quantifying some parameters of infant suction capacity and demonstrate its use in assisting the evaluation of ankyloglossia.

Objetivo: Comparar a sucção infantil em bebês com e sem anquiloglossia usando um sensor de pressão controlado por microprocessador acoplado a uma chupeta.

Método: Cinquenta e cinco lactentes de 0 a 2 meses de idade foram submetidos ao exame clínico de anquiloglossia, em seguida foi oferecido uma chupeta de silicone conectada ao dispositivo de aquisição de pressão e a atividade de sucção foi registrada. Assim, obtivemos dados sobre a frequência de sucções dentro de um período de sucções, a duração média da sucção, a duração da rajada, o número de sucções por rajada, a amplitude máxima das sucções por rajada e o intervalo entre rajadas. O teste t não pareado foi utilizado para comparações entre os grupos.

Resultados: A principal diferença dos recém-nascidos com anquiloglossia em relação aos do grupo controle é que eles realizam rajadas mais longas durante a atividade de sucção.

Conclusão: A duração mais longa das rajadas é provavelmente uma estratégia compensatória e pode estar por trás da dor relatada pelas mães durante a amamentação. Portanto, propomos um método para quantificar objetivamente alguns parâmetros da sucção infantil e demonstramos seu uso para auxiliar na avaliação da anquiloglossia.

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Conflict of interest statement

Conflict of interests: nothing to declare

Figures

Figure 1
Figure 1. Representation of the prototype, signal and extracted variables. A. Block diagram of the prototype. The pressure sensor is connected to one of the microcontroller A/D ports on the platform. The color display shows the profile of the pressure variations in the pacifier graphically. The data relating to pressure sweeps is stored sequentially in a memory card connected to the platform. The pacifier was connected to the sensor through a silicone tube. A stainless-steel tube was introduced to allow the air to flow between the pacifier and the pressure sensor. The solenoid valve connects the pressure measurement route with the external environment. B. Front view of the device with pacifier and the connection. C. Representative recording of non-nutritive suction activity from an infant, and an explanation of the analyzed variables. Note that sucks cluster in stereotypical bursts of activity. a: sucks per burst. b: burst width c: inter-burst interval. d: suck duration. e: maximum amplitude of sucks per burst
Figure 2
Figure 2. Representative recordings from four subjects from the control (blue) and ankyloglossia (red) groups. Note that babies diagnosed with ankyloglossia have clearly longer bursts in comparison to controls. Scale bars are applicable to all recordings
Figure 3
Figure 3. Objective measures of sucking patterns in the control (blue) and ankyloglossia (red) groups. A: mean frequency of sucks. B: mean duration of individual sucks. C: mean amplitude of sucks per burst. D: mean RMS of number of sucks per burst. E: mean inter-burst interval greater than 1.5 seconds. E. mean burst between intervals greater than 1.5 seconds, possible to note a significant increase in the ankyloglossia’s group. Black lines indicate medians. F. mean duration of bursts
Figure 4
Figure 4. Subjective measures of pain during breastfeeding and long feeding in the control (blue) and ankyloglossia (red) groups. Comparison of the presence of pain during breastfeeding in both groups revealed a significant increase in the group with ankyloglossia (upper panels, p<0.01) and a trend increase for reports of longer feeding the group with ankyloglossia
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