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Resolving feeding difficulties with early airway intervention in Pierre Robin Sequence
Michael E Lidsky1, Timothy A Lander, James D Sidman
1Georgetown University School of Medicine, Washington, D.C., U.S.A.
The Laryngoscope
|November 3, 2007
Summary
Early airway intervention in Pierre Robin Sequence (PRS) prevents gastrostomy tube (g-tube) placement in isolated cases. However, airway intervention does not prevent g-tube need in PRS with additional syndromes.
Area of Science:
- Pediatric surgery
- Craniofacial anomalies
- Neonatal care
Background:
- Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
- Feeding difficulties are common in PRS, often necessitating gastrostomy tube (g-tube) placement.
- The role of airway intervention in mitigating feeding issues in PRS requires further investigation.
Purpose of the Study:
- To determine the rate of g-tube placement in infants with PRS.
- To evaluate if early airway intervention resolves feeding difficulties in PRS patients.
- To analyze the impact of PRS with additional syndromes on g-tube requirements.
Main Methods:
- Retrospective review of 67 PRS patients referred to a multidisciplinary cleft team (1988-2006).
- Analysis of g-tube placement, neurological disorders, and airway interventions (tracheotomy, mandibular distraction osteogenesis).
- Patients categorized into isolated PRS (iPRS) and syndromic PRS (sPRS), and by timing of airway intervention (early vs. late/none).
Main Results:
- Of 51 iPRS patients, none requiring early airway intervention needed a g-tube, while 12.8% of those with late/no intervention did.
- In 16 sPRS patients, 87.5% needing early airway intervention still required a g-tube.
- 50% of sPRS patients with late/no airway intervention also required a g-tube.
Conclusions:
- Early airway intervention effectively resolves feeding difficulties and prevents g-tube placement in isolated PRS.
- Delayed airway intervention in iPRS increases the likelihood of g-tube dependency.
- Additional syndromes in PRS significantly complicate management, with most patients requiring g-tubes irrespective of airway intervention timing.
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