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Neonatal Micrognathia: National Trends in Early Mandibular Surgery
Hillary E Jenny1, Benjamin B Massenburg, E Hope Weissler
1From the Mount Sinai Cleft and Craniofacial Center, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY.
Insights
Infants with micrognathia (small jaw) requiring long mechanical ventilation, experiencing apnea, or having a cleft palate may benefit from early mandibular surgery. This can help predict which newborns need timely surgical intervention for breathing and feeding issues.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Anomalies
Background:
- Micrognathia, a congenital anomaly, can cause significant breathing and feeding difficulties in newborns.
- These limitations may necessitate invasive interventions, highlighting the need for timely surgical assessment.
- Identifying predictors for early surgical intervention is crucial for improving infant outcomes.
Purpose of the Study:
- To identify complications associated with mandibular surgery in newborns during their initial hospital stay.
- To predict which infants with micrognathia may benefit from early surgical intervention.
- To inform the standardization of indications for early mandibular distraction osteogenesis.
Main Methods:
- Retrospective cohort study utilizing the 2000-2012 Kids' Inpatient Databases.
- Inclusion of all live newborn infants.
- Multivariate logistic regression to analyze factors associated with mandibular surgery for micrognathia.
Main Results:
- Micrognathia occurred in 0.005% of nearly 20 million births; 4% underwent mandibular surgery during admission.
- Early mandibular surgery was associated with cleft palate, apnea, obstructive sleep apnea (OSA), and prolonged mechanical ventilation.
- Intubation and tracheostomy were not significantly associated with early mandibular surgery.
Conclusions:
- Long mechanical ventilation, apnea, cleft palate, and OSA are key indicators for considering early mandibular surgery in infants with micrognathia.
- These findings aid clinicians in standardizing indications for procedures like mandibular distraction osteogenesis.
- Early surgical intervention can potentially mitigate breathing and feeding challenges in affected newborns.
Background:
Micrognathia is a congenital anomaly that may pose breathing and feeding limitations in newborns, sometimes necessitating invasive management. The present study aims to identify the complications associated with receiving mandibular surgery during the birth stay in order to better predict which patients may benefit from early surgical intervention.
Methods:
A retrospective cohort study was performed using the 2000 to 2012 kids' inpatient databases. We included all live newborn infants born in the hospital through vaginal delivery or caesarean section. We used multivariate logistic regression to investigate the demographic and clinical factors associated with receiving mandibular surgery for micrognathia during the birth stay.
Results:
Of 19,638,453 births, 999 were diagnosed with micrognathia (0.005%). Forty (4%) patients with micrognathia underwent mandibular surgery during the initial admission. On univariate analysis in newborns with micrognathia, mandibular surgery during birth stay was associated with cleft palate, apnea, intubation, tracheostomy, obstructive sleep apnea (OSA), and long mechanical ventilation. Multivariate analysis supported the association between mandibular surgery during the initial admission and long mechanical ventilation (odds ratio [OR], 24.6; 95% confidence interval [CI], 7.7-78.5), OSA (OR, 24.9; 95% CI, 2.5-261.8), apnea (OR, 4.2; 95% CI, 1.5-11.3), and cleft palate (OR, 4.6; 95% CI, 2.0-10.6). However, intubation and tracheostomy were not found to be associated with early mandibular surgery during the birth stay.
Conclusions:
The present study identified long mechanical ventilation, apnea, cleft palate, and OSA as factors indicating patients who may benefit from early mandibular surgery, such as mandibular distraction osteogenesis. These findings may bring the clinician closer to standardizing the indications for early mandibular distraction osteogenesis.
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