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Outcomes in children under 12 months of age undergoing adenotonsillectomy for sleep-disordered breathing

Jeffrey Cheng1, Lisa Elden

  • 1Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia.

The Laryngoscope
|July 4, 2013
PubMed

Insights

Adenotonsillectomy is effective for treating sleep-disordered breathing (SDB) in healthy infants under 12 months. However, it is less effective in infants with comorbidities, and carries a high risk of complications requiring pediatric intensive care unit (PICU) monitoring.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Sleep Medicine
  • Pediatric Surgery

Background:

  • Sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) are significant concerns in infants.
  • Adenotonsillectomy is a common treatment for OSA/SDB in older children, but its use in infants is less established.
  • Infants present unique challenges due to their small airway size and potential for perioperative complications.

Purpose of the Study:

  • To evaluate the incidence, safety, and efficacy of adenotonsillectomy for SDB/OSA in infants 12 months and younger.
  • To assess the outcomes of adenotonsillectomy in healthy infants versus those with comorbid conditions.
  • To identify risks and complications associated with adenotonsillectomy in this young population.

Main Methods:

  • A retrospective case series study was conducted.
  • Data were collected from pediatric patients aged 12 months or younger who underwent adenotonsillectomy between 2006 and 2012.
  • Patient demographics, comorbidities, length of stay, postoperative complications, and treatment efficacy were analyzed.

Main Results:

  • Adenotonsillectomy was performed on 25 infants (average age 10.6 months), with most being male.
  • The procedure was highly effective in healthy infants (100% success) but less effective in those with comorbidities (38.5% success).
  • Postoperative complications occurred in 28% of patients, necessitating pediatric intensive care unit (PICU) admission for monitoring, often due to oxygen requirements.

Conclusions:

  • Adenotonsillectomy is uncommonly performed in infants under 12 months but can be effective, particularly in healthy infants.
  • The risk of postoperative complications is high in this age group, underscoring the need for vigilant PICU monitoring.
  • Potential for adenoid regrowth exists, and patients/families should be counseled regarding possible revision surgery.
Abstract

Keywords:
Adenotonsillectomyobstructive sleep apneasleep disordered breathing

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