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Initial treatment and early weight gain of children with Robin Sequence in Germany: a prospective epidemiological
Christoph Maas1, Christian F Poets1
1Department of Neonatology, University Hospital, Tuebingen, Germany.
Insights
Robin Sequence (RS) affects 11.3 per 100,000 live births in Germany. Non-surgical treatments like the pre-epiglottic baton plate (PEBP) improve infant weight gain, while airway obstruction impacts it negatively.
Area of Science:
- Pediatric Medicine
- Genetics
- Public Health
Background:
- Robin Sequence (RS) is a congenital condition characterized by specific facial and airway abnormalities.
- Understanding the birth prevalence and management strategies for RS is crucial for improving infant outcomes.
- Factors influencing weight gain in infants with RS require further investigation to optimize nutritional support.
Purpose of the Study:
- To determine the birth prevalence of Robin Sequence (RS) in Germany.
- To document the distribution of treatments implemented for infants diagnosed with RS.
- To identify factors affecting weight gain during the initial hospitalization period for these infants.
Main Methods:
- A prospective, population-based survey was conducted from August 2011 to July 2013, including new hospital admissions of infants with RS in Germany.
- RS was defined by retrognathia/micrognathia and associated symptoms like airway obstruction, feeding difficulties, or cleft palate.
- Birth prevalence was calculated using national statistics, and in-hospital weight gain was assessed using SD scores (SDS); statistical comparisons were made using appropriate tests.
Main Results:
- A birth prevalence of 11.3 per 100,000 live births was identified, with 151 RS patients verified.
- Orthodontic therapy (feeding plate or pre-epiglottic baton plate, PEBP) and prone positioning were the most common interventions; tracheotomy was rare.
- Infants with severe respiratory issues experienced greater weight loss (SDS decrease), while PEBP treatment correlated with improved weight gain.
Conclusions:
- Non-surgical management approaches are predominantly favored for infants with Robin Sequence in Germany.
- The severity of upper airway obstruction appears to be a significant factor influencing in-hospital weight gain.
- The use of the pre-epiglottic baton plate (PEBP) is associated with enhanced early weight gain in infants with RS.
Background:
To investigate birth prevalence of Robin Sequence (RS), distribution of implemented treatments and factors influencing weight gain during initial hospitalisation.
Methods:
Prospective population-based survey (August 2011-July 2013) on new hospital admissions of infants with RS in Germany. RS was defined as retrognathia/micrognathia and at least one of the following: upper airway obstruction, snoring or hypoxaemia; glossoptosis; feeding difficulties; failure to thrive; cleft palate or RS-associated syndrome. Birth prevalence was calculated using data from the National Bureau of Statistics and in-hospital weight gain evaluated by calculating differences in SD scores (SDS) for weight. Comparisons between cohorts were performed using the Wilcoxon/Kruskal-Wallis test or Fisher's exact test.
Results:
151 patients with RS could be verified resulting in a birth prevalence of 11.3 per 100,000 live births. Orthodontic therapy (feeding plate or pre-epiglottic baton plate, PEBP) was applied most frequently (107 infants), followed by prone positioning (97 infants). Tracheotomy was rarely performed (n=7). For 115 infants, implementation of more than one intervention was reported. Infants with serious respiratory difficulties during initial hospitalisation (n=58) showed a more pronounced decrease in SDS for weight (median (IQR) -0.81 (-1.32 to -0.26) vs -0.48 (-0.86 to 0.02); p=0.008) whereas treatment with PEBP was associated with better weight gain (SDS-difference for weight -0.37 (-1.06 to 0.02) vs -0.74 (-1.09 to -0.35); p=0.022).
Conclusions:
Non-surgical management is preferred for infants with RS in Germany. The extent of upper airway obstruction seemed to influence in-hospital weight gain, while use of the PEBP was associated with improved early weight gain.
