The Saga of Pulse Oximetry Screening for Critical Congenital Heart Disease in Israel: A Historical Perspective.

BACKGROUND: Many countries have adopted a mandatory routine pulse oximetry screening of newborn infants to identify babies with otherwise asymptomatic critical congenital heart disease (CCHD). OBJECTIVES: To describe the current status of pulse oximetry CCHD screening in Israel, with a special emphasis on the experience of the Shaare Zedek Medical Center. METHODS: We review the difficulties of the Israeli Medical system with adopting the SaO2 screening, and the preliminary results of the screening at the Shaare Zedek Medical Center, both in terms of protocol compliance and CCHD detection. RESULTS: Large scale protocol cannot be implemented in one day, and regular quality assessment programs must take place in order to improve protocol compliance and identify the reasons for protocol failures. CONCLUSIONS: Quality control reviews should be conducted soon after implementation of the screening to allow for prompt diagnosis and quick resolution.

Upper Lip Tie and Breastfeeding: A Systematic Review.

BACKGROUND: Upper lip tie (ULT) articles have been recorded in Medline since 1998, while "labial frenum" articles have been recorded since 1946. OBJECTIVE: to study the existing medical literature on ULT (or labial frenum or fraenum) as they relate to breastfeeding. MATERIALS AND METHODS: Medline search engine was used to determine and subsequently retrieve all articles published on ULT from 1946 to 2018. Key-words of upper lip tie OR labial frenum were used for the search. We also used Google Scholar and Embase to widen our search, and used the PRISMA criteria for systematic reviews (SRs). Articles were classified as case reports (or series), reviews, editorials (or opinions), cohort studies, clinical trials (nonrandomized), randomized controlled trials (RCT), and SRs according to Medline's own classification. We systematically summarized all articles published to date. RESULTS AND CONCLUSION: No RCT were found, and the evidence for routine ULT release in infants with breastfeeding difficulties is poor. The classification system proposed by Kotlow has not been found reliable both in terms of inter and intraobserver agreement and in terms of predicting the severity of the breastfeeding difficulties.

A Dramatic Increase in Tongue Tie-Related Articles: A 67 Years Systematic Review.

BACKGROUND: Tongue tie or ankyloglossia articles are recorded in the Medline since 1949. OBJECTIVE: To study trends in yearly number of tongue tie or ankyloglossia publications. METHODS: Medline search engine was used to determine the yearly number of published consensus statements from 1949 to 2016. Keywords of tongue tie OR ankyloglossia OR frenotomy OR frenulotomy were used for the search. Articles were classified as case reports (or series), reviews, editorials (or opinions), cohort studies, clinical trials (nonrandomized), randomized controlled trials (RCT), and systematic reviews (SR). Linear or polynomial regression was used to determine trends. We also systematically summarized all RCTs published to date. RESULTS: The total number of yearly published articles increased in a cubic fashion (r2 = 82.6%, p < 0.0001) over time (0-7 per year from 1949 to 1989, and up to 27-44 in the last 5 years). In terms of strength of evidence hierarchy, most articles belonged to low hierarchy categories (case reports 37.9%, reviews 15.4%, and editorials/opinions 13.4%), with only 8 RCTs and 10 SRs (all of them published during the last 10 years of the study period). CONCLUSION: The yearly number of tongue tie or ankyloglossia-related articles has increased dramatically in past few years. Most articles bring little evidence, but the past few years have witnessed publication of few RCTs and SRs. If this trend continues, much more solid evidence should accumulate about diagnosis and management of tongue tie, as it relates to breastfeeding and other outcomes.