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Gasparin M, Barth FL, Schweiger C, Collares MVM, Levy DS, Marostica PJC. Sensory-Motor-Oral Stimulation Combined with Early Sucking During the Mandibular Distraction Osteogenesis Process in Children with Robin Sequence. Cleft Palate Craniofac J 2024:10556656241264710. [PMID: 39051575 DOI: 10.1177/10556656241264710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To describe the findings of children with Robin Sequence (RS) who received sensory-motor-oral stimulation combined with early sucking during mandibular distraction osteogenesis (MDO), compared with children who did not receive the intervention. DESIGN A quasi-experimental study. Setting: A tertiary public hospital. Patients: Children with RS referred to MDO. A historical group from the same population but managed according to the institution's standard protocol (no sucking) served as a control group. Interventions: Sensory-motor-oral stimulation, including sucking, starting 24 h after MDO (intervention group). Main Outcome Measure: Our hypothesis is that sensory-motor-oral stimulation, including sucking during the DOM process, do not negatively affect surgical outcomes. RESULTS Twenty-nine children were included. Eight (72.7%) of the 11 patients in the intervention group and 13 (72.2%) of the 18 controls had MDO complications, with no significant difference between the groups (p = 1.000). The most common surgical outcome was antibiotic therapy for surgical site infection (76.2%). Six months after MDO, 22 (75.9%) children attained full oral feeding or associated with alternative feeding methods. CONCLUSION The intervention group did not have higher complication rates, from a surgical point of view, than control group. The protocol adopted by some centers that contraindicates sucking during MDO should be revised to consider the benefits of such stimulation. Keywords: Pierre Robin Syndrome, deglutition, therapeutics, child development.
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Affiliation(s)
- Marisa Gasparin
- Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabiola Luciane Barth
- Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cláudia Schweiger
- Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Otorhinolaryngology Service, Pediatric Otorhinolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | | | - Paulo José Cauduro Marostica
- Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pediatric Pulmonology Unit, Pediatrics Service, HCPA, Porto Alegre, Brazil
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Gasparin M, Barth FL, Pauletti LF, Simon MISDS, da Nóbrega Figueiredo RI, Schweiger C, Levy DS, Marostica PJC. Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis. Dysphagia 2023; 38:1267-1276. [PMID: 36763186 DOI: 10.1007/s00455-023-10561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.
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Affiliation(s)
- Marisa Gasparin
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | - Fabiola Luciane Barth
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | - Luciane Ferreira Pauletti
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | - Miriam Izabel Souza Dos Santos Simon
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | | | - Cláudia Schweiger
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Department of Otolaryngology, Pediatric Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Av. Protásio Alves, 211, Porto Alegre, RS, 90035-903, Brazil
| | - Deborah Salle Levy
- School of Speech-Language Pathology and Audiology, UFRGS, Rua Ramiro Barcelos 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Paulo José Cauduro Marostica
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Department of Pediatrics, Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, Av. Protásio Alves, 211, Porto Alegre, RS, 90035-903, Brazil
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Manica D, Schweiger C. The role of upper airway endoscopy in craniofacial malformations. Semin Fetal Neonatal Med 2021; 26:101293. [PMID: 34561176 DOI: 10.1016/j.siny.2021.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature. METHODS A narrative review was performed, based on a search in pubmed. RESULTS UAE use was reviewed over five domains: 1) Diagnosis of glossoptosis and endoscopic classification: drug-induced sleep endoscopy is recommended to graduate tongue base obstruction; there is still no consensus on the graduation system to be used. 2) Airway abnormalities: there is a high incidence of additional lesions in conjunction with glossoptosis. 3) Swallowing evaluation: a formal comparison with fluoroscopy (gold standard) has not yet been performed in this population. 4) Intubation: thin bronchoscopes allow intubation of small babies; moreover, intubation with rigid video-assisted laryngoscopes show a high success rate in this population. 5) Treatment outcome monitoring: there is no consensus on the ideal parameters to be checked. CONCLUSION Some approaches have already been well established in the management of patients with craniofacial malformations, e.g. the endocopic evaluation of glossoptosis and associated lesions and its role as an intubation assistance tool, while others need to be subject of further research, e.g. its role in swallowing investigation and as a postoperative success control predictor.
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Affiliation(s)
- Denise Manica
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
| | - Cláudia Schweiger
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
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Demoro CCDS, Fontes CMB, Trettene ADS, Cianciarullo TI, Lazarini IM. Applicability of Orem: training of caregiver of infant with Robin Sequence. Rev Bras Enferm 2019; 71:1469-1473. [PMID: 29972549 DOI: 10.1590/0034-7167-2016-0562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to report the nurses' experience in relation to the training of caregivers of infants with Isolated Robin Sequence (IRS) for maintaining care after hospital discharge from the perspective of Self-Care Theoretical Framework. METHOD the following categories were considered in this experience report: self-care action, self-care capacity, therapeutic self-care demand, self-care deficit, and nursing system. The nursing system was wholly compensatory and supportive-educative. RESULTS caregivers' training by nurses results in the acquisition of technical skills and specific knowledge related to the infant's positioning in elevated ventral decubitus, nasopharyngeal intubation, feeding-facilitating techniques and care with the feeding tube. FINAL CONSIDERATIONS the continuity of home care is guaranteed from caregivers' training for the therapeutic demand.
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Santos RDS, Janini JP, Oliveira HMDS. The transition of breastfeeding children with cleft palate and lip among women. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2018-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To discuss the maternal transition in the breastfeeding process of children with cleft lip and palate, from the perspective of the transition theory. Method: Qualitative research of the case study type. The semi-structured interview was used as a data collection instrument. The results were analyzed from the Transition Theory. Results: The participant presented the transitions: situational, developmental and health-illness due to the change of social roles, the need to care for the child with malformation and the changes in her life due to her child's illness. It was identified, in the participant, the difficulty of exercising maternal breastfeeding care, interfering in its developmental and situational transition. Conclusion and implications for practice: The transitions were ineffective in taking into account the transitions covered. The presence of a nursing professional in the evaluation, follow-up and supplementation of the mother in the suckling of children with cleft lip and palate is essential to achieve the healthy transition.
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Souza NFHD, Pereira PJS, Farinha FT, Menezes DC, Bom GC, Trettene ADS. SEQUÊNCIA DE ROBIN ISOLADA: DIAGNÓSTICOS DE ENFERMAGEM. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018004420017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar os diagnósticos de enfermagem em lactentes com Sequência de Robin isolada. Método: estudo descritivo desenvolvido em um hospital especializado em anomalias craniofaciais e síndromes relacionadas, no período de novembro de 2015 a março de 2016. Participaram 20 lactentes com Sequência de Robin isolada. Para a coleta de dados utilizou-se o histórico de enfermagem. Os diagnósticos de enfermagem foram elencados segundo a Nanda-Internacional. Para confecção dos resultados utilizou-se a análise estatística descritiva. Resultados: foram identificados oito diagnósticos, sendo cinco com foco no problema e três de risco, incluindo: risco de aspiração (n=20, 100%); risco de infecção (n=20, 100%); amamentação ineficaz (n=19, 95%); nutrição desequilibrada: menor do que as necessidades corporais (n=19, 95%); padrão ineficaz de alimentação do lactente (n=19, 95%); risco de integridade da pele prejudicada (n=18, 90%); desobstrução ineficaz das vias aéreas (n=11, 55%) e ventilação espontânea prejudicada (n=11, 55%). Conclusão: lactentes com Sequência de Robin isolada apresentaram diagnósticos de enfermagem que se relacionaram a problemas respiratórios, alimentares, de segurança e conforto e favoreceram o planejamento e implementação dos cuidados de enfermagem ao traçarem um perfil assistencial.
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The role of flexible fiberoptic laryngoscopy in Robin Sequence: A systematic review. J Craniomaxillofac Surg 2017; 45:210-215. [DOI: 10.1016/j.jcms.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/29/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022] Open
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Paes EC, de Vries IAC, Penris WM, Hanny KH, Lavrijsen SW, van Leerdam EK, Rademaker MM, Veldhoen ES, Eijkemans RMJC, Kon M, Breugem CC. Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study. Clin Oral Investig 2016; 21:2063-2076. [PMID: 27868158 PMCID: PMC5487830 DOI: 10.1007/s00784-016-1996-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies. MATERIAL AND METHODS A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients. RESULTS RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47-100 %), and 55 % (range = 11-100 %) of infants need NG-tube feeding. CONCLUSIONS FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up. CLINICAL RELEVANCE This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.
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Affiliation(s)
- Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Iris A C de Vries
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Wouter M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Karlijn H Hanny
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Selma W Lavrijsen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Elselien K van Leerdam
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maaike M Rademaker
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rene M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Trettene ADS, Luiz AG, Razera APR, Maximiano TDO, Cintra FMRN, Monteiro LM. [Nursing workload in specialized Semi-intensive Therapy unit: workforce size criteria]. Rev Esc Enferm USP 2016; 49:960-6. [PMID: 27419680 DOI: 10.1590/s0080-623420150000600012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 10/06/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the nursing workload (NW) in Semi-intensive Therapy Unit, specialized in the care of children with Craniofacial anomalies and associated syndromes; to compare the amount of workforce required according to the Nursing Activities Score (NAS) and the COFEN Resolution 293/04. METHOD Cross-sectional study, whose sample was composed of 72 patients. Nursing workload was assessed through retrospective application of the NAS. RESULTS the NAS mean was 49.5%. Nursing workload for the last day of hospitalization was lower in patients being discharged to home (p<0.001) and higher on the first compared to last day of hospitalization (p< 0.001). The number of professionals required according to NAS was superior to the COFEN Resolution 293/04, being 17 and 14, respectively. CONCLUSION the nursing workload corresponded to approximately 50% of the working time of nursing professional and was influenced by day and outcome of hospitalization. The amount of professionals was greater than that determined by the existing legislation.
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Affiliation(s)
- Armando Dos Santos Trettene
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brazil.,Universidade Paulista, Bauru, SP, Brazil
| | - Aline Godoi Luiz
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação, Residência Multiprofissional em Saúde, Bauru, SP, Brazil
| | - Ana Paula Ribeiro Razera
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brazil
| | - Thaís de Oliveira Maximiano
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação, Residência Multiprofissional em Saúde, Bauru, SP, Brazil
| | - Flavia Maria Ravagnani Neves Cintra
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Programa de Pós-Graduação em Ciências da Reabilitação, Bauru, SP, Brazil
| | - Laressa Manfio Monteiro
- Universidade Estadual Paulista Júlio de Mesquita Filho, Programa de Pós-Graduação em Enfermagem, Botucatu, SP, Brazil
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Alencar TRR, Marques IL, Bertucci A, Prado-Oliveira R. Neurological Development of Children With Isolated Robin Sequence Treated With Nasopharyngeal Intubation in Early Infancy. Cleft Palate Craniofac J 2016; 54:256-261. [PMID: 27043650 DOI: 10.1597/14-228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The study assessed the neurodevelopment of children with isolated Robin sequence (IRS) and evaluated if children treated exclusively with nasopharyngeal intubation (NPI) present delay in neurological development. The prospective and cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Children with IRS were divided into two groups according to the type of treatment in early infancy: 38 were treated with NPI (more severe cases) and 24 with postural treatment (less severe cases). Regarding interventions, children were assessed at 2 to 6 years of age using the Denver II Developmental Screening Test (Denver II) and Neurological Evolutionary Examination (NEE). According to Denver II, 73.7% in the NPI group and 79.2% in the postural group presented normal development. This result was similar to the results of different studies in the literature with typical population. Considering all areas of development, there were no significant differences in Denver II between the NPI and postural groups (P = .854). In the NPI group, 89.5% of children and 87.5% in the postural group presented normal development in NEE. Language was the most affected area, as 18.4% and 20.8% of children in NPI and postural group, respectively, presented risk for delay in the Denver II. The increased risk for delay in language area was probably due to anatomical conditions of the muscles involved in speech, and to hearing oscillations, as 47.4% in NPI group and 58.3% in postural group underwent myringotomy. IRS treated with NPI had neurological development similar to those in less severe cases. Children treated exclusively with NPI did not present delay in neurological development.
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Henry CR, Denny AD. Reformatted 3D airway imaging in patients with airway obstruction and micrognathia. J Craniomaxillofac Surg 2015; 43:2004-11. [DOI: 10.1016/j.jcms.2015.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022] Open
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In Situ and Home Care Nasopharyngeal Intubation Improves Respiratory Condition and Prevents Surgical Procedures in Early Infancy of Severe Cases of Robin Sequence. BIOMED RESEARCH INTERNATIONAL 2015; 2015:608905. [PMID: 26273635 PMCID: PMC4529914 DOI: 10.1155/2015/608905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the clinical outcome of infants with Robin Sequence (RS) and severe respiratory obstruction managed with nasopharyngeal intubation (NPI). METHODS This prospective study was conducted with 107 infants with RS admitted to the Hospital for Craniofacial Anomalies of the University of São Paulo (HRAC-USP), from July 2003 to June 2010, diagnosed with severe RS and treated with NPI. The infants were followed up for the first year of life. Clinical findings, morbidity, and mortality were recorded. RESULTS Of the 223 infants with RS admitted to the hospital in the period studied, 149 were diagnosed with severe respiratory distress and 107 (71.81%) matched all the inclusion criteria. Of those, 78 (73%) presented Isolated Robin Sequence and 29 (27%) presented other syndromes or anomalies associated with RS. NPI treatment lasted an average of 57 days and the mean hospitalization time was 18 days. Although all infants presented feeding difficulties, 85% were fed orally and only 15% underwent gastrostomy. Morbidity was 14% and no deaths occurred. CONCLUSIONS The children treated with the RS treatment protocol adopted at the HRAC-USP had improved respiratory and feeding difficulties, required a shorter hospitalization time, and presented low morbidity and mortality during the first year of life. The general outcome prevented surgical procedures in early infancy.
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Pierre Robin sequence: review of diagnostic and treatment challenges. Int J Pediatr Otorhinolaryngol 2015; 79:451-64. [PMID: 25704848 DOI: 10.1016/j.ijporl.2015.01.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 11/23/2022]
Abstract
Pierre Robin sequence is not a rare condition and paediatric specialists caring for respiratory related issues are likely to encounter cases in their practice. There have been a few recent reviews on the topic, mostly focusing on the surgical interventions performed for cases with severe airway obstruction. In the present review, we will highlight the different challenges that remain today in the global evaluation of infants afflicted with this condition through a thorough review of the medical literature, giving the clinician a full scope of the disease and of the various management options. The need for an improved objective evaluation of airway obstruction and for a better classification will be emphasized. We are therefore proposing a novel classification scheme that will better account for respiratory and feeding difficulties in these infants. Finally, many knowledge gaps persist regarding this condition, underlining the necessity for further research both in the genetic field and regarding the outcome of therapy.
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Paes EC, van Nunen DPF, Speleman L, Muradin MSM, Smarius B, Kon M, Mink van der Molen AB, Niers TLEM, Veldhoen ES, Breugem CC. A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm. Clin Oral Investig 2015; 19:2101-14. [PMID: 25680705 PMCID: PMC4592702 DOI: 10.1007/s00784-015-1407-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
Abstract
Objectives Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature. Material and methods A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS. Results Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p = .014). A mandibular distraction was conducted in 24 % (n = 18) of cases, a tracheotomy in 9 % (n = 7), and a tongue–lip adhesion in 8 % (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described. Conclusions RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended. Clinical Relevance We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.
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Affiliation(s)
- Emma C Paes
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Daan P F van Nunen
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Lucienne Speleman
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Marvick S M Muradin
- Department of Oral and Cranio-Maxillofacial Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Bram Smarius
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Titia L E M Niers
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Prado-Oliveira R, Marques IL, Souza LD, Souza-Brosco TVD, Dutka JDCR. Assessment of speech nasality in children with Robin Sequence. Codas 2015; 27:51-7. [DOI: 10.1590/2317-1782/20152014055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/29/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To report the outcomes of primary palatoplasty in Robin Sequence (RS); to verify the relationship between modalities of assessment of nasality; to compare nasality between techniques at palatoplasty. METHODS: This study involved the identification of hypernasality in four modalities: live assessment with 4-point scale; live assessment with cul-de-sac test; multiple listeners' ratings of recorded phrase; nasometric assessment. Live ratings of speech nasality and nasalance scores were retrieved from charts, while a recorded phrase was rated by listeners for occurrence of hypernasality. Agreement between the modalities was established as well as association between nasality, nasal turbulence and age at surgery and at assessment. Fisher's exact test was used to compare findings between surgical techniques. RESULTS: Agreement between nasalance, live assessment with 4-point scale, live assessment with cul-de-sac, and multiple listeners' ratings of recorded samples ranged between reasonable (0.32) and perfect (1.00). Percentage occurrence of hypernasality varied largely between assessment modalities. Mean occurrence of hypernasality was lower for the group submitted to Furlow technique (26%) than the group that received von Langenbeck technique (53%). Only findings obtained live were statistically significant (scale: p=0.012; cul-de-sac: p<0.001). Listeners identified nasal turbulence for 22 (32%) samples out of the 69 recordings, and an association was found between hypernasality and nasal turbulence. CONCLUSION: Lower occurrence of hypernasality was identified for patients with RS in Furlow group. Identification of hypernasality varied largely among the four assessment modalities.
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Cladis F, Kumar A, Grunwaldt L, Otteson T, Ford M, Losee JE. Pierre Robin Sequence. Anesth Analg 2014; 119:400-412. [DOI: 10.1213/ane.0000000000000301] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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