Anquiloglossia neonatal e amamentação: análise da produção científica, desenvolvimento e validação de instrumento para avaliação do manejo de neonatos na atenção primária

Abstract

Ankyloglossia is a genetic alteration that occurs during embryonic development, resulting in modifications to the lingual frenulum, making it shorter, thicker, or positioned more anteriorly on the tongue, thereby limiting its movements. This limitation can lead to consequences such as difficulties in swallowing, sucking, and interference with breastfeeding. The objective of this study was to map the profile of abstracts on ankyloglossia published in the proceedings of the Brazilian Society for Dental Research (SBPqO) over the past decade and to develop a tool to identify the flow of care for newborns in the primary healthcare network (PHC) concerning neonatal ankyloglossia. For the mapping, a bibliometric analysis was conducted through consultations of the Annual Meeting Proceedings of SBPqO. Abstracts were selected through a full-text review by two independently trained reviewers, followed by a consensus meeting, and, if necessary, a third reviewer made the final decision. Clinical studies that assessed the lingual frenulum, oral alterations, protocols, and frenotomy were included. Of the 26 abstracts obtained, only 12 focused on the diagnosis of ankyloglossia, with cross-sectional observational studies being the most frequent. Only eight studies reported receiving funding, and 14 mentioned applying a protocol for diagnosing ankyloglossia, with the Bristol protocol being the most cited, while only two referenced UNICEF's breastfeeding protocol. It was observed that few abstracts on ankyloglossia in infants were published over the past decade in the SBPqO proceedings, highlighting the need to emphasize this topic to avoid overtreatment and reduce potentially unnecessary surgeries. In developing the tool, two questionnaires were designed, targeting dentists and nurses who hold positions as head nurses and/or technical supervisors (RT), including questions on key aspects of ankyloglossia, breastfeeding, and newborn management. The questionnaires were pretested and evaluated by 10 specialists. For content validation, a Content Validity Index (CVI) was calculated using a Likert scale scored from 1 to 4, where higher scores indicate greater item relevance. Items with a CVI above 0.80 were considered representative/relevant, while those with a CVI below 0.80 were mandatorily revised or excluded. The dentists' questionnaire included 38 questions (4 open-ended and 34 closed-ended), achieving a CVI and evaluator agreement score of 0.92. The questionnaire for head nurses/RT included 27 questions (4 open-ended and 23 closed-ended), achieving a CVI of 0.93 and complete evaluator agreement of 1. Based on the CVI results, our questionnaire demonstrated good applicability for dentists and head nurses/RT in the PHC network, showing strong representativeness, validity, and internal consistency.