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Published on: September 16, 2019
Detection of Chronic Hypoventilation Among Infants With Robin Sequence Using Capillary Blood Gas Sampling
James T Kwan1, Bridget E Ebert2, Brianne B Roby2,3
1Department of Otolaryngology - Head & Neck Surgery, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.
Insights
Capillary blood gas (CBG) sampling can detect hypoventilation in infants with Robin sequence (RS). Objective measures of respiratory acidosis may appear by day of life 9 in infants needing airway intervention.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Medical Diagnostics
Background:
- Robin sequence (RS) is a congenital condition that can lead to airway obstruction and hypoventilation in infants.
- Early detection and quantification of hypoventilation are crucial for timely intervention and improved outcomes in infants with RS.
Purpose of the Study:
- To evaluate the utility of capillary blood gas (CBG) sampling in identifying and measuring hypoventilation in infants diagnosed with Robin sequence.
- To establish objective criteria for detecting respiratory acidosis in this population.
Main Methods:
- A retrospective case series involving chart review of 111 infants with RS over a 10-year period.
- Analysis of CBG values, including PCO2 and HCO3 levels, obtained during infancy until airway intervention (AI) or discharge.
Main Results:
- 73% of infants (81/111) required AI, with mandibular distraction osteogenesis being the most common procedure.
- Infants requiring AI showed significantly higher mean PCO2 (52.7 mmHg) and HCO3 (29.8 mEq/L) levels between days of life 7-30 compared to those not requiring AI.
- Cutoff values for PCO2 and HCO3 were established, with infants needing AI surpassing these thresholds by a median of day of life 9.
Conclusions:
- Capillary blood gas sampling provides objective measures for detecting respiratory acidosis in infants with Robin sequence.
- These objective measures may become apparent as early as day of life 9 in infants who ultimately require airway intervention.
Objectives/Hypothesis:
To describe the use of capillary blood gas (CBG) sampling to detect and quantify hypoventilation in infants with Robin sequence (RS).
Methods:
Case series with chart review at two institutions. Infants with RS presenting over a 10-year period were identified using departmental databases. CBG values obtained during infancy or until airway intervention (AI) were reviewed.
Results:
From 2008 to 2018, 111 infants with RS were identified as having had been assessed and managed from birth or transfer until discharge home and having CBG data available. In most cases, CBG sampling was obtained every other day until intervention or discharge. A total of 81 (73%) infants required AI: 72 (89%) underwent mandibular distraction osteogenesis, five (6%) underwent tracheotomy, and four (5%) were discharged home with a nasopharyngeal airway. The mean PCO2 at day of life (DOL) 7-30 for the AI group was 52.7 mmHg (95% confidence interval: 51.7-53.7) and for the no AI group was 45.9 mmHg (44.8-47.0; P < .0001). The mean HCO3 at DOL 7-30 for the AI group was 29.8 mEq/L (29.4-30.1) and for the no AI group was 27.0 mEq/L (26.5-27.4; P < .0001). Receiver operating characteristic curves were created for maximum PCO2 and HCO3 values and cutoffs were established by optimizing a balance of sensitivity and specificity. Infants requiring AI surpassed the PCO2 and HCO3 cutoff at a median of DOL 9.
Conclusions:
Among infants with RS and hypoventilation, objective measures of respiratory acidosis may be apparent by DOL 9.
Level Of Evidence:
4 Laryngoscope, 131:2789-2794, 2021.
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