20.500.12556/RUL-188327 Vloga ankiloglosije pri težavah s hranjenjem in požiranjem pri donošenih novorojenčkih The Role of Ankyloglossia in Feeding and Swallowing Problems in Full-term Newborns Hranjenje in požiranje predstavljata eni izmed najpomembnejših funkcij v zgodnjem obdobju otrokovega razvoja. Poleg zagotavljanja ustreznega vnosa hranil omogočata rast, razvoj ter vzpostavljanje zgodnjih interakcij med otrokom in starši. Čeprav se hranjenje pri večini donošenih novorojenčkov razvija brez večjih težav, se pri delu otrok pojavljajo različne motnje in odstopanja, ki lahko vplivajo na učinkovitost hranjenja, pridobivanje telesne mase ter kakovost življenja. Njihovi vzroki so lahko številni in vključujejo anatomske, fiziološke ter okoljske dejavnike. Med pogosto obravnavanimi anatomskimi dejavniki je tudi ankiloglosija oziroma prekratka podjezična sredinska guba (PSG), ki lahko omejuje gibljivost jezika in vpliva na učinkovitost sesanja, požiranja ter dojenja. V zadnjih letih zanimanje za področje ankiloglosije narašča, hkrati pa se povečujejo tudi razprave o njenem vplivu na hranjenje in potrebi po kirurški obravnavi. Kljub številnim raziskavam ostajajo številna vprašanja odprta. V literaturi ni enotnih diagnostičnih meril, uporabljajo se različni klasifikacijski sistemi in ocenjevalni protokoli, rezultati raziskav o vplivu ankiloglosije na hranjenje pa niso vedno skladni. Zato ostaja potreba po nadaljnjem raziskovanju tega področja, zlasti pri donošenih novorojenčkih. Empirični del temelji na raziskavi, ki je bila izvedena na vzorcu 333 donošenih novorojenčkov. Podatke o težavah pri hranjenju smo zbirali z vprašalnikom takoj po rojstvu ter dva meseca in tri mesece po rojstvu. Vprašalnike smo sestavili na podlagi literature in v sodelovanju s strokovnjaki iz prakse ter jih uporabili za namen raziskave. Z raziskavo smo želeli preučiti pojavnost težav s hranjenjem in požiranjem pri donošenih novorojenčkih ter dejavnike, ki so z njimi povezani. Posebna pozornost je bila namenjena vlogi ankiloglosije, njenemu vplivu na hranjenje in požiranje ter morebitnemu vplivu kirurške prekinitve podjezične sredinske gube. Z raziskavo smo spremljali hranjenje otrok v zgodnjem neonatalnem obdobju ter dva in tri mesece po rojstvu, kar omogoča vpogled v potek in izzvenevanje težav skozi čas. V prvih dneh po rojstvu je pediater v porodnišnici ocenil otrokovo podjezično sredinsko gubo s pomočjo grafičnega ocenjevalnega protokola ankiloglosije pri dojenih otrocih (TABBY) in se odločil o morebitni kirurški prekinitvi podjezične gube. Primerjali smo rezultate vprašalnika med otroki z in brez ankiloglosije v porodnišnici in 2 meseca po odpustu iz porodnišnice ter ugotavljali morebiten pozitiven vpliv operacije na hranjenje. V porodnišnici je imelo težave s hranjenjem 13,8% otrok od 333 donošenih novorojenčkov. Na pojav težav s hranjenjem so vplivali način poroda (otroci, rojeni s carskim rezom so imeli pogosteje težave, p = 0,037), prvorojenost (p = 0,021), prisotnost ankiloglosije (p = 0,026) in materino doživljanje stresa pri hranjenju (p < 0,001). Ankiloglosija se je torej pri donošenih novorojenčkih v univariatni analizi pokazala kot dejavnik, povezan s pogostejšim pojavljanjem težav s hranjenjem in požiranjem, vendar povezava v binarni logistični regresiji ni bila statistično značilna. Samo 308 otrok je bilo ocenjenih s TABBY, pri 39 je bila na podlagi ocene TABBY postavljena diagnoza ankiloglosije. Frenulotomija je bila napravljena pri 33 novorojenčkih. Med otroki z ankiloglosijo jih je imelo težave s hranjenjem 25,6 %, med otroki brez ankiloglosije pa 13,0 %. Po operaciji se je samo pri 25,8 % otrok z ankiloglosijo hranjenje izboljšalo. Dva meseca po odpustu je odgovorilo na vprašalnik samo 240 mater otrok. Med njimi jih je 11,4 % navajalo, da imajo njihovi otroci še vedno težave s hranjenjem. Ti so prejeli enak vprašalnik 3 mesece po odpustu. Takrat je 17 izmed 37 staršev, ki so odgovorili na poslani vprašalnik, navajalo težave s hranjenjem. To predstavlja 5,1 % otrok začetnega vzorca. Med njimi je bilo 10,3 % otrok z ankiloglosijo, oziroma 7 (17,9 %) otrok, ki so imeli napravljeno frenulotomijo. Iz rezultatov lahko sklepamo, da se težave s hranjenjem pojavijo pri 13,8 % zdravih donošenih novorojenčkov, vendar pri večini težave v treh mesecih po odpustu iz porodnišnice izzvenijo. Ankiloglosija je dejavnik, ki povečuje možnost težav s hranjenjem pri zdravih novorojenčkih, vendar pa kirurška terapija izboljša stanje samo pri eni četrtini teh otrok. Nadaljnje raziskave bodo morda lahko odgovorile na vprašanje, pri katerih otrocih z ankiloglosijo lahko pričakujemo izboljšanje hranjenja po kirurškem posegu na sredinski podjezični gubi. Feeding and swallowing are among the most important functions in the early period of child development. In addition to ensuring adequate nutritional intake, they enable growth, development, and the establishment of early interactions between the child and parents. Although feeding develops without major difficulties in most full-term newborns, some children present with various disorders and deviations that may affect feeding efficiency, weight gain, and quality of life. Their causes can be numerous and include anatomical, physiological, and environmental factors. Among the frequently discussed anatomical factors is ankyloglossia, or a short lingual frenulum, which may limit tongue mobility and affect the efficiency of sucking, swallowing, and breastfeeding. The empirical part is based on a study conducted on a sample of 333 full-term newborns. Data were collected using a questionnaire immediately after birth, as well as at two and three months after birth. The questionnaires were developed based on literature and in collaboration with professionals from clinical practice and were used for the purposes of this study. In recent years, interest in ankyloglossia has been increasing, along with ongoing debates regarding its impact on feeding and the need for surgical intervention. Despite numerous studies, many questions remain unresolved. There is a lack of uniform diagnostic criteria in the literature, and various classification systems and assessment protocols are used; moreover, research findings on the impact of ankyloglossia on feeding are not always consistent. Therefore, further research in this area remains necessary, particularly in full-term newborns. The aim of the study was to investigate the prevalence of feeding and swallowing difficulties in full-term newborns and the factors associated with their occurrence. Particular attention was given to the role of ankyloglossia, its impact on feeding and swallowing, and the potential effect of surgical intervention on the lingual frenulum. Feeding was monitored during the early neonatal period and two and three months after birth, providing insight into the course and resolution of feeding difficulties over time. In the first days after birth, a paediatrician at the maternity hospital assessed the infant’s lingual frenulum using the Tongue-tie and Breastfed Babies (TABBY) assessment tool and determined whether surgical intervention on the lingual frenulum was indicated. Questionnaire results were compared between children with and without ankyloglossia at the maternity hospital and two months after discharge, and the potential positive effect of surgery on feeding was assessed. In the maternity hospital, 13,8% of the 333 term newborns experienced feeding difficulties. The occurrence of feeding difficulties was associated with mode of delivery (feeding difficulties were more common among children born by caesarean section, p = 0,037), being a first-born child (p = 0,021), the presence of ankyloglossia (p = 0,024), and maternal experience of stress during feeding (p < 0,001). Thus, in term newborns, ankyloglossia was identified as a factor associated with a higher occurrence of feeding and swallowing difficulties in the univariate analysis; however, this association was not statistically significant in the binary logistic regression analysis. Only 308 children were assessed using the TABBY tool, and ankyloglossia was diagnosed based on the TABBY score in 39 children. Frenulotomy was performed in 33 newborns. Among children with ankyloglossia, 25,6 % experienced feeding difficulties, compared with 13,0 % of children without ankyloglossia. Following surgery, feeding improved in only 25,8 % of children with ankyloglossia. Two months after discharge, only 240 mothers completed the questionnaire. Of these, 11,4 % reported that their children still experienced feeding difficulties. These mothers were sent the same questionnaire three months after discharge. At that time, 17 of the 37 parents who responded reported feeding difficulties. This represented 5,1 % of the children in the initial sample. Among these children, 10,3 % had ankyloglossia, including 7 (17,9 %) children who had undergone frenulotomy. The results suggest that feeding difficulties occur in 13,8 % of healthy term newborns; however, in most children, these difficulties resolve within three months after discharge from the maternity hospital. Ankyloglossia is a factor associated with an increased likelihood of feeding difficulties in healthy newborns; however, surgical treatment improves feeding in only one quarter of these children. Further research may help determine which children with ankyloglossia are most likely to experience improved feeding following surgical intervention on the lingual frenulum. razvoj hranjenja motnje hranjenja motnje požiranja novorojenčki podjezična sredinska guba ankiloglosija diagnostični postopki kirurška terapija feeding development feeding disorders swallowing disorders newborns lingual frenulum ankyloglossia diagnostic procedures surgical treatment true false false Slovenski jezik Angleški jezik Magistrsko delo/naloga 2026-09-20 08:30:06 2026-09-20 08:30:11 2026-09-21 04:28:23 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 210896 54425.pdf 54425.pdf 1 1C166E8AA3944FDE11357302F76C3B94 e8258d2b0a4033f4d24b246376f8955f2707efec3d799fe5f0ec62eee6f1435c ad03bfd4-b4bc-11f1-8bc5-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=248360 Pedagoška fakulteta 0 0 0