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Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective
Pleun P J M van der Plas1, Gwen G M van Heesch2, Maarten J Koudstaal1
1Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Non-surgical management improved breathing in infants with Robin Sequence (RS). However, feeding difficulties and impaired weight gain persist, highlighting the need for early intervention to support growth.
Area of Science:
- Pediatric Pulmonology
- Neonatal Care
- Clinical Outcomes Research
Background:
- Robin Sequence (RS) presents significant challenges in airway management, feeding, and growth during infancy.
- Effective non-surgical interventions are crucial for optimizing outcomes in infants with RS.
Purpose of the Study:
- To evaluate the clinical outcomes of non-surgical respiratory management in infants with Robin Sequence.
- To assess the impact on airway, feeding, and growth during the first year of life.
Main Methods:
- Prospective study of 36 infants with Robin Sequence treated between 2011 and 2021.
- Interventions included positional therapy and respiratory support.
- Outcomes measured via polysomnography, blood gas values, feeding requirements, and weight/height standard deviation scores (SDS).
Main Results:
- Respiratory outcomes improved, with decreased apnea-hypopnea index and enhanced oxygen levels.
- 86% of infants experienced feeding difficulties, resolving in 71% within the first year.
- Weight-for-age SDS worsened from -0.40 to -1.03 by one year of age.
Conclusions:
- Non-surgical respiratory treatment effectively improves respiratory function in infants with RS.
- Persistent feeding difficulties and impaired weight gain necessitate early recognition and treatment.
- Optimizing growth requires a comprehensive approach addressing both respiratory and nutritional needs.
Objective:
To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence.
Design:
Prospective study.
Setting:
Sophia Children's Hospital, Rotterdam, the Netherlands.
Patients/ Participants:
36 patients with Robin Sequence who were treated between 2011 and 2021.
Interventions:
Positional therapy and respiratory support.
Main Outcome Measure(S):
Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA).
Results:
Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from -0.40 to -0.33 to -1.03, respectively.
Conclusions:
Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.
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