Management of airway obstruction in infants with pierre robin sequence

Christopher M. Runyan, Armando Uribe-Rivera, Shahryar Tork, Tasneem Shikary, Zarmina Ehsan, K. Nicole Weaver, Md Monir Hossain, Christopher B. Gordon, Brian S. Pan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined. Methods: A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions. Results: The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group. Conclusions: Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.

Original languageEnglish (US)
Article numbere1688
JournalPlastic and Reconstructive Surgery - Global Open
Volume6
Issue number5
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Pierre Robin Syndrome
Tracheostomy
Distraction Osteogenesis
Airway Obstruction
Low Birth Weight Infant
Micrognathism
Nervous System
Tongue
Physical Examination
Sleep
Demography
Newborn Infant
Sensitivity and Specificity

ASJC Scopus subject areas

  • Surgery

Cite this

Management of airway obstruction in infants with pierre robin sequence. / Runyan, Christopher M.; Uribe-Rivera, Armando; Tork, Shahryar; Shikary, Tasneem; Ehsan, Zarmina; Weaver, K. Nicole; Hossain, Md Monir; Gordon, Christopher B.; Pan, Brian S.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 6, No. 5, e1688, 01.01.2018.

Research output: Contribution to journalArticle

Runyan, CM, Uribe-Rivera, A, Tork, S, Shikary, T, Ehsan, Z, Weaver, KN, Hossain, MM, Gordon, CB & Pan, BS 2018, 'Management of airway obstruction in infants with pierre robin sequence', Plastic and Reconstructive Surgery - Global Open, vol. 6, no. 5, e1688. https://doi.org/10.1097/GOX.0000000000001688
Runyan, Christopher M. ; Uribe-Rivera, Armando ; Tork, Shahryar ; Shikary, Tasneem ; Ehsan, Zarmina ; Weaver, K. Nicole ; Hossain, Md Monir ; Gordon, Christopher B. ; Pan, Brian S. / Management of airway obstruction in infants with pierre robin sequence. In: Plastic and Reconstructive Surgery - Global Open. 2018 ; Vol. 6, No. 5.
@article{52c6d2f394b54179a533356892a79d1a,
title = "Management of airway obstruction in infants with pierre robin sequence",
abstract = "Background: Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined. Methods: A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions. Results: The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11{\%} of those treated conservatively had an OI >20, whereas 67.5{\%} of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2{\%} and 100.0{\%}, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group. Conclusions: Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.",
author = "Runyan, {Christopher M.} and Armando Uribe-Rivera and Shahryar Tork and Tasneem Shikary and Zarmina Ehsan and Weaver, {K. Nicole} and Hossain, {Md Monir} and Gordon, {Christopher B.} and Pan, {Brian S.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/GOX.0000000000001688",
language = "English (US)",
volume = "6",
journal = "Plastic and Reconstructive Surgery - Global Open",
issn = "2169-7574",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "5",

}

TY - JOUR

T1 - Management of airway obstruction in infants with pierre robin sequence

AU - Runyan, Christopher M.

AU - Uribe-Rivera, Armando

AU - Tork, Shahryar

AU - Shikary, Tasneem

AU - Ehsan, Zarmina

AU - Weaver, K. Nicole

AU - Hossain, Md Monir

AU - Gordon, Christopher B.

AU - Pan, Brian S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined. Methods: A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions. Results: The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group. Conclusions: Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.

AB - Background: Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined. Methods: A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions. Results: The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group. Conclusions: Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.

UR - http://www.scopus.com/inward/record.url?scp=85065190110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065190110&partnerID=8YFLogxK

U2 - 10.1097/GOX.0000000000001688

DO - 10.1097/GOX.0000000000001688

M3 - Article

AN - SCOPUS:85065190110

VL - 6

JO - Plastic and Reconstructive Surgery - Global Open

JF - Plastic and Reconstructive Surgery - Global Open

SN - 2169-7574

IS - 5

M1 - e1688

ER -