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Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases
Fabian Blanc1, Inge Harrewijn2, Claire Duflos3
1Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France.
Insights
Nasopharyngeal airway tubes are effective first-line treatments for Pierre Robin sequence (PRS) respiratory issues. Achieving exclusive oral feeding can predict the severity of breathing problems in infants with PRS.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Care
- Congenital Disorders
Background:
- Pierre Robin sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
- Airway obstruction in PRS can lead to significant respiratory distress in newborns, requiring prompt management.
- Initial care practices for PRS vary, impacting patient outcomes and the need for interventions.
Purpose of the Study:
- To describe initial care strategies for infants diagnosed with Pierre Robin sequence (PRS).
- To identify factors that predict the severity of breathing disorders in children with PRS.
- To evaluate the effectiveness of nasopharyngeal airway tubes (NT) as a primary treatment.
Main Methods:
- Retrospective single-center study of 150 children with PRS, treated between 1986 and 2017.
- Patients were categorized into three groups based on respiratory management: no specific intervention, prone positioning, or nasopharyngeal airway tube (NT)/surgery.
- Analysis of clinical data, including age of exclusive oral feeding and need for respiratory support.
Main Results:
- 19% of patients required NT or surgical intervention, while 39% needed prone positioning.
- No significant differences in preterm birth, birth weight, or congenital malformations were found between groups.
- The age of exclusive oral feeding was significantly delayed in infants requiring more intensive respiratory management (Group 2: 11 days, Group 3: 39 days) compared to Group 1 (1 day).
- Nasopharyngeal airway tube (NT) use relieved upper airway obstruction in 14 assessed children.
Conclusions:
- Nasopharyngeal airway tube (NT) has become a primary treatment for PRS, effectively managing airway obstruction and avoiding complex procedures.
- The ability to achieve exclusive oral feeding appears to be a reliable predictor of respiratory symptom severity in infants with Pierre Robin sequence (PRS).
Objectives:
To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders.
Design:
A retrospective single-center study of 150 children with PRS.
Setting:
Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS.
Patients:
A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment.
Main Outcome Measures:
Evolution and results of the initial treatment of PRS.
Results:
Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children.
Conclusions:
Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.
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