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Wright M, Knowles RL, Cortina-Borja M, Javadpour S, Mehendale FV, Urquhart DS. Airway management in infants with Robin sequence in the United Kingdom and Ireland: A prospective population-based study. Pediatr Pulmonol 2024; 59:2839-2849. [PMID: 39031808 DOI: 10.1002/ppul.27140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/06/2024] [Accepted: 06/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE There is currently no consensus about managing upper airway obstruction (UAO) in infants with Robin sequence (RS), in terms of treatment efficacy or clinical outcomes. This study describes UAO management in UK/Ireland, and explores relationships between patient characteristics, UAO management, and clinical outcomes in the first 2 years of life. METHODS Active surveillance of RS throughout UK/Ireland via the British Paediatric Surveillance Unit and nationally commissioned cleft services. Clinical data were collected at initial notification and 12-month follow-up. RESULTS 173 infants with RS were identified, of which 47% had additional congenital anomalies or an underlying syndrome (non-isolated RS). Two-thirds (n = 119) required an airway intervention other than prone positioning: non-surgical in 84% and surgical (tracheostomy) in 16%. Nasopharyngeal airway (NPA) was the most common intervention, used in 83% (n = 99) for median 90 days (IQR 136). Surgical UAO management was associated with prolonged hospital admission, higher prevalence of neurodevelopmental delay (NDD), lower weight-for-age z-scores, and delayed oral feeding. These findings were not attributable to a higher prevalence of non-isolated RS in this group. Although more commonly associated with non-isolated RS, growth faltering was also identified in 48%, and NDD in 18%, of cases of isolated RS. CONCLUSIONS In UK/Ireland, most infants with RS are managed with NPA, and tracheostomy is reserved for refractory severe UAO. Clinical outcomes and duration of use indicate that NPA is a safe and feasible first-line approach to UAO. Longitudinal assessment of neurodevelopment and growth is imperative, including in children with isolated RS. Current variations in practice reinforce the need for evidence-based treatment guidelines.
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Affiliation(s)
- Marie Wright
- Division of Paediatric Respiratory Medicine, BC Children's Hospital, Vancouver, Canada
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
- Department of Population, Policy and Practice Research and Teaching, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel L Knowles
- Department of Population, Policy and Practice Research and Teaching, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mario Cortina-Borja
- Department of Population, Policy and Practice Research and Teaching, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sheila Javadpour
- Division of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Felicity V Mehendale
- Global Cleft Lip and Palate Research Programme, Global Health Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Don S Urquhart
- Division of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
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2
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Choo H, Davis AS, Bain LC, Ahn H. Weight Gain of Infants with Robin Sequence Treated Nonsurgically Using the Stanford Orthodontic Airway Plate (SOAP): 1-Year Follow-Up. Cleft Palate Craniofac J 2024:10556656241233239. [PMID: 38373407 DOI: 10.1177/10556656241233239] [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: 02/21/2024] Open
Abstract
OBJECTIVE To identify weight gain trends of infants with Robin sequence (RS) treated by the Stanford Orthodontic Airway Plate treatment (SOAP). DESIGN Retrospective longitudinal cohort study. SETTING Single tertiary referral hospital. PATIENTS Eleven infants with RS treated with SOAP. INTERVENTIONS Nonsurgical SOAP. MAIN OUTCOME MEASURES Body weight, Weight-for-age (WFA) Z-scores, and WFA percentiles at birth (T0), SOAP delivery (T1), SOAP graduation (T2), and 12-months old (T3). RESULTS Between T0 and T1, the weight increased but the WFA percentile decreased from 36.5% to 15.1%, and the Z-score worsened from -0.43 to -1.44. From T1 to T2, the percentile improved to 22.55% and the Z-score to -0.94. From T2 to T3, the percentile and the Z-scores further improved to 36.59% and -0.48, respectively. CONCLUSIONS SOAP provided infants experiencing severe respiratory distress and oral feeding difficulty with an opportunity to gain weight commensurate with the WHO healthy norms without surgical intervention.
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Affiliation(s)
- HyeRan Choo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Lisa C Bain
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - HyoWon Ahn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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3
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Polytarchou A, Moudaki A, Van de Perck E, Boudewyns A, Kaditis AG, Verhulst S, Ersu R. An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life. Eur Respir Rev 2024; 33:230121. [PMID: 38296343 PMCID: PMC10828842 DOI: 10.1183/16000617.0121-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea-hypopnoea index >5 events·h-1 may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.
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Affiliation(s)
- Anastasia Polytarchou
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
- These authors contributed equally to this review article and share first authorship
| | - Angeliki Moudaki
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
- These authors contributed equally to this review article and share first authorship
| | - Eli Van de Perck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- These authors contributed equally to this review article and share first authorship
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Stijn Verhulst
- Department of Pediatric Pulmonology and Sleep Medicine, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
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Semensato MM, Trindade SHK, Marzano-Rodrigues MN, Scomparin L, Trindade-Suedam I. Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence. Cleft Palate Craniofac J 2024; 61:79-86. [PMID: 36443934 DOI: 10.1177/10556656221119078] [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] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN Prospective, observational, and cross-sectional study. SETTING Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.
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Affiliation(s)
- Mariana Mendes Semensato
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil
| | - Sergio Henrique Kiemle Trindade
- Bauru School of Medicine and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil
| | - Maria Noel Marzano-Rodrigues
- Bauru School of Medicine and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil
| | - Leandro Scomparin
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil
| | - Ivy Trindade-Suedam
- Bauru School of Medicine and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil
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Stefanovski D, Tapia IE, Lioy J, Sengupta S, Mukhopadhyay S, Corcoran A, Cornaglia MA, Cielo CM. Respiratory indices during sleep in healthy infants: A prospective longitudinal study and meta-analysis. Sleep Med 2022; 99:49-57. [DOI: 10.1016/j.sleep.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
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Choo H, Galera RI, Balakrishnan K, Lin HFC, Ahn H, Lorenz P, Khosla RK, Profit J, Poets CF, Lee JS. Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up. Cleft Palate Craniofac J 2022; 60:758-767. [PMID: 35167404 DOI: 10.1177/10556656221076980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.
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Affiliation(s)
- HyeRan Choo
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rhona I. Galera
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karthik Balakrishnan
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hung-Fu C. Lin
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - HyoWon Ahn
- KyungHee University Dental Hospital, Seoul, Korea
| | - Peter Lorenz
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rohit K. Khosla
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jochen Profit
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Janice S. Lee
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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Kukkola HLK, Vuola P, Seppä-Moilanen M, Salminen P, Kirjavainen T. Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants. Arch Dis Child 2021; 106:954-960. [PMID: 34244167 DOI: 10.1136/archdischild-2020-320527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/22/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated. DESIGN To complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position. RESULTS One-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient. CONCLUSIONS The incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.
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Affiliation(s)
| | - Pia Vuola
- Pediatric Research Center, Helsinki, Finland.,Cleft and Craniofacial Center Husuke, Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Maija Seppä-Moilanen
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland.,Pediatric Research Center, Helsinki, Finland
| | - Päivi Salminen
- Department of Pediatric Surgery, New Children's Hospital, Helsinki, Finland
| | - Turkka Kirjavainen
- Department of Pediatrics, New Children's Hospital, Helsinki, Finland .,Pediatric Research Center, Helsinki, Finland.,Department of Clinical Neurophysiology and Neurological Sciences, New Children's Hospital, Helsinki, Finland
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8
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Baker-Smith CM, Isaiah A, Melendres MC, Mahgerefteh J, Lasso-Pirot A, Mayo S, Gooding H, Zachariah J. Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2021; 10:e022427. [PMID: 34404224 PMCID: PMC8649512 DOI: 10.1161/jaha.121.022427] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular disease in adults. It is associated with incident systemic hypertension, arrhythmia, stroke, coronary artery disease, and heart failure. OSA is common in children and adolescents, but there has been less focus on OSA as a primary risk factor for cardiovascular disease in children and adolescents. This scientific statement summarizes what is known regarding the impact of sleep‐disordered breathing and, in particular, OSA on the cardiovascular health of children and adolescents. This statement highlights what is known regarding the impact of OSA on the risk for hypertension, arrhythmia, abnormal ventricular morphology, impaired ventricular contractility, and elevated right heart pressure among children and adolescents. This scientific statement also summarizes current best practices for the diagnosis and evaluation of cardiovascular disease–related complications of OSA in children and adolescents with sleep apnea and highlights potential future research in the area of sleep‐disordered breathing and cardiovascular health during childhood and adolescence.
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van Eeden S, Wren Y, McKean C, Stringer H. Early Communication Behaviors in Infants With Cleft Palate With and Without Robin Sequence: A Preliminary Study. Cleft Palate Craniofac J 2021; 59:984-994. [PMID: 34259062 PMCID: PMC9272514 DOI: 10.1177/10556656211031877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the early communication behaviors in infants with nonsyndromic isolated cleft palate (iCP) and Robin sequence (RS). DESIGN Group comparison using parent report. PARTICIPANTS There were 106 participants included in this study. Two groups were selected from the UK Cleft Collective resource. Parents had completed the Language ENvironment Analysis Developmental Snapshot questionnaire when their child turned 13 months. There were 78 participants in the iCP group and 28 in the RS group. MAIN OUTCOME MEASURE(S) Total number of communication behaviors reported on the questionnaire. Subdomains for expressive and receptive language and social communication behaviors were also analyzed. RESULTS There were no statistically significant group differences. Parents of infants with RS reported fewer later communication behaviors compared to the iCP group. Infants in both groups had fewer communication behaviors compared to the normative sample. Across the whole sample, post hoc analysis revealed a significant correlation between severity of the cleft and social communication behaviors and expressive but not receptive language. Infants with a cleft of the hard and soft palate were more likely to be in the RS group (odds ratio: 7.04 [95% CI: 1.55-32.04]; P = .01). CONCLUSIONS Both groups reported similar levels of early communication. Some divergence of more complex language skills was seen, although there were no significant group differences. A relationship with the diagnosis of a cleft of the hard or soft palate with expressive language behaviors was found. Further study into the impact of cleft severity on early speech development and the relationship with later language skills is needed along with longitudinal follow-up of this population.
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Affiliation(s)
- Stephanie van Eeden
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, United Kingdom.,1980University of Bristol, Bristol, United Kingdom
| | - Cristina McKean
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Stringer
- School of Education, Communication and Language Sciences, 5994Newcastle University, Newcastle upon Tyne, United Kingdom
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10
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MacLean JE. Laryngomalacia in infancy improves with increasing age irrespective of treatment. J Clin Sleep Med 2021; 17:619-620. [PMID: 33551020 DOI: 10.5664/jcsm.9128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
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11
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Soto E, Ananthasekar S, Kurapati S, Robin NH, Smola C, Maddox MH, Boyd CJ, Myers RP. Mandibular Distraction Osteogenesis as a Primary Intervention in Infants With Pierre Robin Sequence. Ann Plast Surg 2021; 86:S545-S549. [PMID: 33833161 PMCID: PMC8601586 DOI: 10.1097/sap.0000000000002702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pierre Robin sequence (PRS) is a triad of congenital facial abnormalities that can present as a syndrome (syndromic PRS [sPRS]) or an isolated entity (isolated PRS [iPRS]). Patients with PRS can develop airway and feeding problems that may result in failure to thrive. Mandibular distraction osteogenesis (MDO) is a method for improving the functional issues associated with breathing and feeding. There is a Paucity of literature evaluating the outcomes of MDO between sPRS and iPRS patients. METHODS An institutional review board-approved retrospective review of PRS patients managed by a single surgeon and treated with MDO between January 2015 and December 2019 at a tertiary referral hospital was performed. The patients were stratified into iPRS or sPRS based on gene testing. Airway outcome measures included avoidance of tracheostomy, relief of sleep apnea, and oxygen saturation improvement. Primary feeding measures included achievement of full oral feeds and growth/weight gain. Statistical analysis included t tests and χ2 tests where appropriate using SPSS. RESULTS Over the study period, of the 29 infants with PRS, 55% identified as iPRS and 45% as sPRS. There were no significant differences in the patient characteristics, apnea-hypoxia index (22.27 ± 12.27) and laryngeal view (3 ± 0.79) pre-MDO. After MDO, 83% of the subjects achieved a positive feeding outcome and 86% achieved a positive airway outcome with no statistical significance between sPRS and iPRS (P = 0.4369). There was a statistically significant change post-MDO in apnea-hypoxia index (5.24 ± 4.50, P = 0.02) and laryngeal view (1.59 ± 1.00, P = 0.01). CONCLUSIONS Our recent experience would lead us to believe that sPRS patients have greater morbidities and challenging clinical developments that, when properly evaluated, can be managed by MDO. There is a potential role for MDO in reducing the need for traditional surgical interventions for respiratory and feeding problems in both iPRS and sPRS patients.
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Affiliation(s)
- Edgar Soto
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Srikanth Kurapati
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Nathaniel H. Robin
- Department of Genetics, University of Alabama at Birmingham School of Medicine
| | - Cassi Smola
- Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Halsey Maddox
- Division of Pediatric Pulmonary & Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Carter J. Boyd
- Division of Plastic Surgery, New York University, New York, NY
| | - René P. Myers
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
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12
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Xu Y, Tan Y, Zhang N, Mao Z, Zhang S, Liang Y. A Standardized Extubation Schedule Reduces Respiratory Events After Extubation Following Mandibular Distraction in Infants. J Oral Maxillofac Surg 2021; 79:2257-2266. [PMID: 34119477 DOI: 10.1016/j.joms.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The rational time for intubation during early mandibular distraction osteogenesis (MDO) in infants is unknown. To investigate the differences in clinical outcomes following MDO before and after a standardized extubation protocol implementation in infants. METHODS A retrospective cohort study was performed for infant patients under 1 year old undergoing MDO. The study population was composed of all patients presenting for evaluation and management who underwent MDO between November 2016 and February 2021. We divided them into 2 groups: the pre-protocol group and the protocol group. The inpatient charts of infants were assessed. The primary outcome was respiratory events after extubation. The secondary outcomes were duration of mechanical ventilation (MV), postoperative length of stay (LOS), and success rate of the first extubation. Other variables included age, sex, weight, height, and information related to diagnosis, distraction, anesthesia, and operation. The logistic regression model and linear regression model were used to calculate unadjusted and adjusted relative risk (RR) and mean difference (MD) for associations between 2 groups and the primary and secondary outcomes. RESULTS There were 142 infants in the pre-protocol group and 135 infants in the protocol group. The patients in the protocol group were heavier in weight than those in the pre-protocol group (P<.05). The Cormack-Lehane grade and the duration of operation and anesthesia were higher and longer in the pre-protocol group than in the protocol group (P<.05). Respiratory events after extubation were significantly more common in the pre-protocol group than in the protocol group [21.1 vs. 9.6%, adjusted relative risk 0.46 (95% CI 0.22-0.89), P <.01]. CONCLUSIONS Among infants undergoing MDO, the standardization of extubation practices can reduce respiratory events after extubation compared with traditional management.
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Affiliation(s)
- Yingyi Xu
- Department of Anaesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yonghong Tan
- Department of Anaesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Na Zhang
- Department of Anaesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhe Mao
- Department of Stomatology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Siyi Zhang
- Department of Anaesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yufeng Liang
- Department of Paediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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13
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Logjes RJH, MacLean JE, de Cort NW, Poets CF, Abadie V, Joosten KFM, Resnick CM, Trindade-Suedam IK, Zdanski CJ, Forrest CR, Kruisinga FH, Flores RL, Evans KN, Breugem CC. Objective measurements for upper airway obstruction in infants with Robin sequence: what are we measuring? A systematic review. J Clin Sleep Med 2021; 17:1717-1729. [PMID: 33960296 DOI: 10.5664/jcsm.9394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in this population. Objective assessments of UAO and treatments are not standardized. A systematic review of objective measures of UAO was conducted as step towards evidence based clinical decision making for RS. METHODS A literature search was performed in Pubmed and Embase databases (1990-2020) following PRISMA-guidelines. Articles reporting on RS and UAO-treatment were included if the following objective measures were studied: oximetry, polysomnography and blood gas. Quality was appraised by methodological index for non-randomized studies (MINORS, range:0-24). RESULTS A total of 91 articles met inclusion criteria. Mean MINORS-score was 7.1 (range:3-14). Polysomnography was most frequently used (76%) followed by oximetry (20%) and blood gas (11%). Sleep position of the infant was reported in 35% of studies, with supine position most frequently, and monitoring time in 42%, including overnight recordings in more than half. Of 71 studies that evaluated UAO-interventions, the majority used polysomnography (90%), of which 61% did not specify the polysomnography technique. Reported polysomnography metrics included oxygen saturation (61%), apnea-hypopnea index (52%), carbon dioxide levels (31%), obstructive-apnea-hypopnea index (27%), and oxygen-desaturation-index (16%). Only 42 studies reported indications for UAO-intervention, with oximetry and polysomnography thresholds used equally (both 40%). In total, 34 distinct indications for treatment were identified. CONCLUSIONS This systematic review demonstrates a lack of standardization, interpretation and reporting of assessment and treatment indications for UAO in RS. An international, multidisciplinary consensus protocol is needed to guide clinicians on optimal UAO assessment in RS.
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Affiliation(s)
- Robrecht J H Logjes
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centre, location AMC & VU, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Alberta, Canada
| | - Noor W de Cort
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany
| | - Véronique Abadie
- Department of General Pediatrics, Necker University Hospital, Paris, France
| | - Koen F M Joosten
- Department Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Harvard Medical School Boston, Boston Children's Hospital, USA
| | - Ivy K Trindade-Suedam
- Sleep Unit, Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil
| | - Carlton J Zdanski
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, USA
| | - Christopher R Forrest
- Division Plastic and Reconstructive Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Frea H Kruisinga
- Department of Pediatrics, Amsterdam University Medical Centre, location AMC, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Kelly N Evans
- Department of Pediatrics, University of Washington, Seattle Children's Craniofacial Center, Seattle, USA
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Centre, location AMC & VU, Emma Children's Hospital, Amsterdam, The Netherlands
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Bandyopadhyay A, Daftary AS. Obstructive Sleep Apnea in Infants During the First Year of Life: What the Pediatrician Needs to Know. Clin Pediatr (Phila) 2020; 59:752-759. [PMID: 32274936 DOI: 10.1177/0009922820915733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Abstract
INTRODUCTION The aim of this study was to evaluate pre-operative nutritional status, associated syndromes and abnormalities, and post-operative outcomes of patients with Pierre Robin Sequence (PRS) versus those with non-syndromic isolated cleft palate (CIP). METHODS Between January 1995 and December 2013, patients with a cleft palate Veau I-II according to the Veau classification with and without PRS who underwent primary repair were retrospectively analyzed. The nutrition status, age at the time of palatoplasty, additional anomalies, gestational complications, and post-operative speech abnormalities and outcomes were evaluated. RESULTS A total of 59 patients with PRS (PRS group) and 132 patients without PRS (non-PRS group) were included in the study. Of all patients, 92 were males and 99 were females with a mean age of 14 ± 4.18 (range, 6 to 26) years. The rate of gestational complications, enteral nutrition, complete cleft, additional anomalies, and velopharyngeal insufficiency was significantly higher in the PRS group (P < 0.05). However, the incidence of fistulas and age at the time of palatoplasty did not significantly differ between the groups. CONCLUSION Based on our study results, enteral nutrition, respiratory problems, pregnancy complications, velopharyngeal insufficiency, and additional anomalies, but not post-operative palatal fistulas, are more frequently seen in patients with PRS. Although pre-operative care and treatment and rehabilitation in patients with PRS are more complicated than those with the CIP, our experience demonstrates that meticulous repair and follow-up can minimize complications, such as fistulas.
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MacLean JE. Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction. J Clin Sleep Med 2019; 15:373-374. [PMID: 30853057 DOI: 10.5664/jcsm.7654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics and Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
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