Management of airway obstruction in infants with pierre robin sequence

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

Research output: Contribution to journalArticle

3 Scopus citations

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 - 2018

ASJC Scopus subject areas

  • Surgery

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    Runyan, C. M., Uribe-Rivera, A., Tork, S., Shikary, T. A., Ehsan, Z., Weaver, K. N., Hossain, M. M., Gordon, C. B., & Pan, B. S. (2018). Management of airway obstruction in infants with pierre robin sequence. Plastic and Reconstructive Surgery - Global Open, 6(5), [e1688]. https://doi.org/10.1097/GOX.0000000000001688