Article type
Abstract
Systematic reviews (SR) when well conducted can help in the deliberation of clinical conduct. This study aimed to perform a critical analysis of systematic reviews (SRs) that evaluated the efficacy lingual frenotomy in breastfeeding infants. The Cochrane Library, PubMed, Embase, LILACS, Web of Science, Scopus and gray literature databases were systematically searched. Inclusion criteria: SRs whose primary studies investigated the efficacy of lingual frenotomy performed on infants up to 1 year of age and analyzed outcomes related to breastfeeding, with or without meta-analysis of randomized or non-randomized studies.
Exclusion criteria: commentaries, opinions, abstracts, protocols, expert opinions, chapters, letters, narrative or integrative literature reviews, scoping reviews, syntheses of reviews, networking meta-analysis, observational studies, descriptive, prognostic, diagnostic, qualitative and mixed methods, methodological, cost-effectiveness, in vitro and in vivo models, studies for which the full text was not assessed. Data extracted: author(s), year, study design, population, sample size, age, country of publication, presence of meta-analysis, main results and conclusions. The breastfeeding-related outcome was mother's self-efficacy. Two independent reviewers performed collected the data and a third reviewer reached consensus. The AMSTAR 2 tool was used to assess methodological quality and identify differences between reviews. Of the 31 SRs identified, 12 were included. Four of them presented meta-analyses and most were published between 2007 and 2023, with a predominance of studies from the United States (58.3%). One SR (8.3%) was classified as low quality due to a lack of information on funding. The rest were classified as critically low quality, with critical items 7 (n=9; 75%) and 13 (n=10; 83.3%) being the most absent. The characteristics of the primary studies revealed several limitations, such as: failures to extract data on location, collection period, follow-up period, language restrictions and small sample size. Many SRs included study designs other than randomized clinical trials or non-randomized clinical trials, with notable heterogeneity among the results. The analysis showed the critically low quality. Based on these limitations the efficacy of lingual frenotomy in breastfeeding efficacy is inconclusive. It highlights the need for improved methodological rigor in primary studies and in future SRs addressing lingual frenotomy in infants.
Exclusion criteria: commentaries, opinions, abstracts, protocols, expert opinions, chapters, letters, narrative or integrative literature reviews, scoping reviews, syntheses of reviews, networking meta-analysis, observational studies, descriptive, prognostic, diagnostic, qualitative and mixed methods, methodological, cost-effectiveness, in vitro and in vivo models, studies for which the full text was not assessed. Data extracted: author(s), year, study design, population, sample size, age, country of publication, presence of meta-analysis, main results and conclusions. The breastfeeding-related outcome was mother's self-efficacy. Two independent reviewers performed collected the data and a third reviewer reached consensus. The AMSTAR 2 tool was used to assess methodological quality and identify differences between reviews. Of the 31 SRs identified, 12 were included. Four of them presented meta-analyses and most were published between 2007 and 2023, with a predominance of studies from the United States (58.3%). One SR (8.3%) was classified as low quality due to a lack of information on funding. The rest were classified as critically low quality, with critical items 7 (n=9; 75%) and 13 (n=10; 83.3%) being the most absent. The characteristics of the primary studies revealed several limitations, such as: failures to extract data on location, collection period, follow-up period, language restrictions and small sample size. Many SRs included study designs other than randomized clinical trials or non-randomized clinical trials, with notable heterogeneity among the results. The analysis showed the critically low quality. Based on these limitations the efficacy of lingual frenotomy in breastfeeding efficacy is inconclusive. It highlights the need for improved methodological rigor in primary studies and in future SRs addressing lingual frenotomy in infants.