Feeding Outcomes for Infants and Parents After Tongue-Tie Surgery: Establishing a Multi-Centre Research Network and Piloting Pre- and Post-Operative Stretch Protocols (CIRENE)
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Dr. Duc-Minh Lam-Do
Pediatric Dentist
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Dr. Brynn Leroux
Pediatric Dentist
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Dr. Sharon Smart
SLP
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Dr. Raymond Tseng
Pediatric Dentist
Background: Frenotomy releases the lingual frenulum to improve feeding in infants with ankyloglossia, but reattachment occurs in 2.6–13% of cases. Pre- and post-operative oral exercises are widely recommended to reduce this risk, but evidence for their efficacy, optimal duration, and impact on feeding outcomes is limited, conflicting, and largely drawn from single-site, underpowered studies. CIRENE, part of the CIREAS Research Network, was established to compare functional feeding outcomes between infants receiving pre- and post-operative exercises versus post-operative exercises only, and to evaluate the effect of caregiver adherence on outcomes in both groups. This required first building an international multi-site network capable of standardised data collection.
Part 1 — Building the network: CIRENE recruited three independent paediatric tongue-tie practices across two countries: North Carolina Tongue Tie Centre (NCTTC), Associates in Paediatric Dentistry (AIPD), and Montreal Tongue Tie Institute (MTTI). Each site differed in workflow, record systems, and staffing. Key challenges included harmonising consent and ethics oversight across jurisdictions (with Curtin University providing centralised IRB and statistical infrastructure), training clinical staff to administer InfantEAT and the Matrix of Infant Feeding (MIF) consistently, standardising timepoints around a shared surgical reference point (B1/B2/P1/P2), and building secure, site-agnostic transfer of de-identified forms into a central REDCap database. Sites also varied in capacity for research administration, requiring flexible data capture (iPad, paper, and hybrid scanned forms) tailored to each site.
Part 2 — Piloting data collection: A quasi-experimental, preference-based design assigned participants to pre- and post-operative exercises or post-operative exercises only, targeting 140 participants (70 per group). As of June 2026, 43 participants are enrolled (24 NCTTC, 13 AIPD, 6 MTTI): 27 male, 16 female, mean enrollment age approximately 5.7 weeks (range 0–14 weeks).
Results: Early pilot data suggest a trajectory difference between groups: the PPO group resolved more symptoms by the one-week follow-up (49% vs. 20% for PO), while the PO group showed a steeper improvement between one and four weeks, with both groups reaching similar overall symptom resolution by four weeks (~65% vs. ~55%). Statistically significant within-group improvements over time were observed for both groups, with several large effect sizes, supporting further investigation of this early-versus-delayed resolution pattern in the larger CIRENE cohort. A full dataset of an estimated 50 participants will be analysed by the end of 2026.