Changes in the incidence and surgical treatment of ankyloglossia in Canada

BACKGROUND

Recent reports show increases in rates of ankyloglossia and frenotomy in British Columbia. We carried out a study to determine temporal trends and regional variations in ankyloglossia and frenotomy in Canada.

METHODS

The study included all hospital-based live births in Canada (excluding Quebec) between April 2002 and March 2015, with information obtained from the Canadian Institute for Health Information. Information on ankyloglossia and frenotomy was obtained from records of hospital admission for childbirth. Temporal trends and provincial/territorial variations were quantified using rate ratios (RR) and 95% confidence intervals (CI).

RESULTS

Ankyloglossia rates increased from 6.86 in 2002 to 22.6 per 1000 live births in 2014 (P for trend < 0.001), while frenotomy rates increased from 3.76 in 2002 to 14.7 per 1000 live births in 2014 (P for trend < 0.001). Frenotomy rates among infants with ankyloglossia increased from 54.7% in 2002 to 63.9% in 2014 (RR: 1.18, 95% CI: 1.13-1.24). Compared with British Columbia, rates of ankyloglossia were over three-fold higher in Saskatchewan (RR: 3.40, 95% CI: 3.16-3.67), Alberta (RR: 3.50, 95% CI: 3.29-3.72) and the Yukon (RR: 3.62, 95% CI: 2.67-4.92), while rates of frenotomy were three- to four-fold higher in the Yukon (RR: 3.41, 95% CI: 2.28-5.10), Alberta (RR: 4.01, 95% CI: 3.71-4.33) and Saskatchewan (RR: 4.12, 95% CI: 3.76-4.52).

CONCLUSION

A desire to increase rates of breast feeding initiation and absence of standardized criteria for the diagnosis of ankyloglossia have resulted in runaway rates of frenotomy for newborn infants in some parts of Canada.

Evaluation of the INTERGROWTH-21st project newborn standard for use in Canada

Objective

To evaluate the performance of the INTERGROWTH-21^st Project newborn standard vis-a-vis the current Canadian birth weight-for-gestational age reference.

Methods

All hospital-based singleton live births in Canada (excluding Quebec) between 2002 and 2012 with a gestational age between 33 and 42 weeks were included using information obtained from the Canadian Institute for Health Information. Small- and large-for gestational age centile categories of the INTERGROWTH standard and Canadian reference were contrasted in terms of frequency distributions and rates of composite neonatal morbidity/mortality.

Results

Among 2,753,817 singleton live births, 0.87% and 9.63% were <3^rd centile and >97^th centile, respectively, of the INTERGROWTH standard, while 2.27% and 3.55% were <3^rd centile and >97^th centile, respectively, of the Canadian reference. Infants <3^rd centile and >97^th centile had a composite neonatal morbidity/mortality rate of 46.4 and 12.9 per 1,000 live births, respectively, under the INTERGROWTH standard and 30.9 and 16.6 per 1,000 live births, respectively, under the Canadian reference. The INTERGROWTH standard <3^rd centile and >97^th centile categories had detection rates of 3.14% and 9.74%, respectively, for composite neonatal morbidity/ mortality compared with 5.48% and 4.60%, respectively for the Canadian reference. Similar patterns were evident in high- and low-risk subpopulations.

Conclusions

The centile distribution of the INTERGROWTH newborn standard is left shifted compared with the Canadian reference, and this shift alters the frequencies and neonatal morbidity/mortality rates associated with specific centile categories. Further outcome-based research is required for defining abnormal growth categories before the INTERGROWTH newborn standard can be used.