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Identifying ankyloglossia in newborns at Paoli Hospital: a quality improvement project
Dissertation

Identifying ankyloglossia in newborns at Paoli Hospital: a quality improvement project

Jill Schwartz
Doctor of Nursing Practice (D.N.P.), Drexel University
Mar 2018
DOI:
https://doi.org/10.17918/etd-7849
pdf
Schwartz_Jill_20184.22 MB
PDF Access upon request, Email title, URL, or DOI to archives@drexel.edu

Abstract

Ankyloglossia Newborn infants--Hospital care
Background: Ankyloglossia or tongue-tie, the tethering of the frenulum under the tongue, can adversely affect breastfeeding by causing a poor latch, maternal nipple pain, and poor milk supply. Not identifying this condition could lead to early breastfeeding cessation. Since nurses at Paoli Hospital are not using evidence-based methods of assessment, they may not be identifying all cases of ankyloglossia. In addition, the best evidence-based method for identifying ankyloglossia has not been established at Paoli Hospital. As popularity in breastfeeding increases, nurses need to know how to assess for ankyloglossia and should be aware of the effects of ankyloglossia on breastfeeding. Purpose: The purpose of this DNP project was to: 1) compare ankyloglossia prevalence rates between the ATLFF (an evidenced based tongue assessment tool) and the prevalence rates using usual nursing tongue assessment, and 2) determine the best objective evidence-based method of ankyloglossia assessment by nurses among healthy newborns before hospital discharge at Paoli Hospital by comparing the BTAT to the ATLFF. Methods and Results: This descriptive comparative design was conducted from October 1 - 28, 2017 using a convenience sample of 130 newborns admitted to the Family-Centered Maternity Unit at Paoli Hospital. Prevalence was found to be 13.8% using the ATLFF and 3.8% as assessed by the nurses' usual tongue assessment methods. The sensitivity and specificity of usual nursing tongue assessment methods relative to the ATLFF was 22% and 99%, respectively. The prevalence of ankyloglossia measured with the BTAT was 18.5% (185 cases per 1000 newborns), compared to the prevalence measured with the ATLFF which was 13.8% (138 cases per 1000 newborns). The sensitivity and specificity of the BTAT relative to the ATLFF was 77.8% and 91.1%, respectively. Among the two raters, Cohen's kappa for the ATLFF and BTAT was calculated to be 0.36 and 0.42, respectively. The intraclass correlation coefficient (ICC) between the ATLFF function scores was 0.77 (95% CI [0.55; 0.88]). The ICC between the ATLFF appearance scores was 0.78 (95% CI [0.12, 0.92]). The ICC of the BTAT scores was determined to be 0.79 (95% CI [0.56, 0.89]). Cronbach's alpha for ATLFF function assessment was 0.79 (95% CI [0.73, 0.84]), while Cronbach's alpha for the ATLFF appearance assessment tool was 0.82 (95% CI [0.76, 0.86]). The overall Cronbach's alpha of the ATLFF assessment scale was 0.88 (95% CI [0.85, 0.91]). Cronbach's alpha for the BTAT was 0.75 (95% CI [0.68, 0.82]). Conclusions: This quality improvement project found that usual nursing subjective assessment did not identify as many cases of ankyloglossia compared to ankyloglossia cases identified using the "gold standard" ATLFF. In addition, the findings suggest that the BTAT is an evidenced-based tongue assessment tool that compares favorably to the ATLFF. Because the BTAT is easier to use, it is recommended nurses use the BTAT for timely ankyloglossia identification to facilitate early referral for frenotomy to achieve optimal breastfeeding outcomes. Future implications are to 1) develop an ankyloglossia assessment protocol for nurses that incorporates the BTAT for ankyloglossia assessment, and 2) measuring hospital ankyloglossia prevalence rates and breastfeeding duration before and after implementation of the protocol.

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