A comparison of airway interventions and gastrostomy tube placement in infants with Robin sequence

Area of Science:

• Pediatric surgery
• Craniofacial anomalies
• Gastroenterology

Background:

• Robin sequence (RS) presents significant airway obstruction challenges in infants.
• Feeding impairment is a common complication, often necessitating gastrostomy tube (G-tube) placement.
• Understanding factors influencing G-tube rates is crucial for optimizing infant care.

Purpose of the Study:

• To evaluate feeding impairment in infants with Robin sequence based on G-tube placement rates.
• To compare G-tube placement rates between non-operative and various operative airway management strategies.
• To identify patient-specific factors associated with increased G-tube dependency.

Main Methods:

• Retrospective study of 225 infants with Robin sequence treated between 1976 and 2018.
• Patients were grouped by airway intervention: non-operative, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), or tracheostomy.
• Statistical analysis compared G-tube placement rates across groups and by patient characteristics (syndromic diagnosis, GI anomalies).

Main Results:

• Operative management (58.1%) had a significantly higher G-tube rate than non-operative management (28.3%).
• Tongue-lip adhesion and tracheostomy groups showed higher odds of G-tube placement compared to MDO.
• Syndromic infants and those with gastrointestinal anomalies had increased odds of G-tube placement.

Conclusions:

• Infants with Robin sequence requiring airway operations, syndromic diagnoses, or gastrointestinal anomalies are more likely to need G-tube placement.
• Mandibular distraction osteogenesis was associated with the lowest G-tube rate among operative interventions.
• Tailored management strategies considering these factors can improve outcomes for infants with Robin sequence.