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Early weight gain in infants with Robin sequence after mandibular distraction
J A Harris1, E Hashim2, K Larson3
1Boston Children's Hospital, Boston, Massachusetts, USA; Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Insights
Infants with Robin sequence (RS) treated by mandibular distraction osteogenesis (MDO) experienced slower initial weight gain but showed accelerated growth post-MDO compared to peers. Feeding tubes impacted weight gain differently across study periods.
Area of Science:
- Pediatric surgery
- Craniofacial anomalies
- Growth and development
Background:
- Robin sequence (RS) is a congenital condition characterized by mandibular hypoplasia.
- Mandibular distraction osteogenesis (MDO) is a surgical procedure used to correct severe micrognathia in RS.
- Assessing post-operative growth is crucial for managing infants with RS.
Purpose of the Study:
- To evaluate the weight gain patterns in infants with RS following MDO.
- To compare infant weight gain to established growth curves.
- To identify factors influencing weight gain in this cohort.
Main Methods:
- Retrospective cohort study design.
- Analysis of average daily weight gain in four distinct post-operative periods.
- Comparison with published growth curves using Wilcoxon matched-pairs signed rank test.
Main Results:
- Infants showed significantly lower weight gain from birth to MDO (T1).
- Post-MDO, infants exhibited significantly higher weight gain from the procedure through 12 months (T2, T3, T4).
- Feeding tube use correlated with improved T1 weight gain but poorer T3 and T4 weight gain.
Conclusions:
- MDO is associated with an initial deficit in weight gain, followed by catch-up growth.
- Weight gain trajectories normalize and exceed expectations after MDO in infants with RS.
- Feeding tube management requires careful consideration in the context of MDO outcomes.
Abstract:
This retrospective cohort study was performed to assess weight gain in infants with Robin sequence (RS) treated by mandibular distraction osteogenesis (MDO). The primary outcome variable was average daily weight gain for the following time periods: (1) birth to MDO (T1), (2) MDO to distractor removal (T2), (3) distractor removal to 6 months later (T3), and (4) 6 months to 12 months following distractor removal (T4). Published growth curves were used for comparison. Differences were assessed using the Wilcoxon matched-pairs signed rank test. Twenty-two infants were included in the study. During T1, the infants had 9.47 ± 12.61 g/day less weight gain than expected (P = 0.001). However, for T2, T3, and T4, the infants demonstrated 3.48 ± 6.17 g/day (P = 0.028), 2.19 ± 4.47 g/day (P = 0.030), and 1.83 ± 3.25 g/day (P = 0.028) more weight gain than expected. Feeding tube use resulted in improved weight gain during T1 (P < 0.001), but was associated with poorer weight gain in T3 (P = 0.003) and T4 (P = 0.001). In conclusion, infants with RS treated by MDO demonstrated poorer weight gain relative to their peers between birth and the MDO operation. However, from the MDO procedure to 12 months post-distractor removal, infants who had MDO showed faster weight gain than their age-matched peers.
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