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MicroNAPS: A Novel Classification for Infants with Micrognathia, Robin Sequence, and Tongue-based Airway Obstruction

Cory M Resnick1,2, Eliot Katz3,4, Alistair Varidel2

  • 1From the Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, Mass.

Plastic and Reconstructive Surgery. Global Open
|September 25, 2023
PubMed

Insights

A new classification system, MicroNAPS, aids in managing Robin sequence (RS) by stratifying patients based on micrognathia, nutrition, airway, palate, and comorbidities. This system improves clinical communication and treatment planning for infants with RS.

Area of Science:

  • Craniofacial abnormalities
  • Pediatric surgery
  • Genetics

Background:

  • Robin sequence (RS) presents a heterogeneous group of infants with micrognathia, glossoptosis, and upper airway obstruction (UAO).
  • Current diagnostic and treatment approaches for RS lack standardization, leading to variability in patient management and research.
  • Existing classification systems for RS are not universally adopted, highlighting the need for a novel, broadly endorsed system.

Purpose of the Study:

  • To develop and validate a novel classification system for Robin sequence (RS).
  • To enhance clinical communication, treatment planning, prognostication, and research inclusion for infants with RS.
  • To create a standardized framework for assessing and managing the complexities of RS.

Main Methods:

  • A retrospective cross-sectional study was conducted to develop and trial the MicroNAPS classification system.
  • The MicroNAPS system incorporates five elements: micrognathia, nutrition, airway, palate, and syndrome/comorbidities.
  • The system was applied to 100 infants with RS, with definitions for stages R0-R4 and a specific stage for tongue-based airway obstruction (TBAO) established.

Main Results:

  • The MicroNAPS system effectively categorized 100 infants with RS, demonstrating distinct clinical characteristics across stages R1-R4.
  • Stage R1 infants had feeding issues, R2 and R3 infants had airway issues managed with surgical interventions, and R4 represented complex phenotypes requiring prolonged care.
  • The R0 (at risk) and TBAO groups showed significant variability, indicating the system's ability to identify diverse patient presentations.

Conclusions:

  • The MicroNAPS classification system is user-friendly and correlates with key disease characteristics in Robin sequence.
  • The proposed system facilitates improved clinical communication and treatment stratification for infants with RS.
  • Adoption of the MicroNAPS system in clinical and research settings is recommended for standardized management and advancement of RS understanding.
Abstract

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