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Predicting Failure of Conservative Airway Management in Infants with Robin Sequence: The EARN Factors

Jennifer L McGrath1, Esperanza Mantilla-Rivas1, Marudeen Aivaz1

  • 1From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|January 3, 2024
PubMed

Insights

Certain polysomnographic findings predict when infants with Robin Sequence (RS) will not improve with conservative airway management. These factors can help identify infants needing earlier surgical intervention for severe upper airway obstruction (UAO).

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Neonatology

Background:

  • Robin Sequence (RS) presents a significant challenge in infant airway management.
  • Conservative airway measures are often the initial approach, but success rates vary.
  • Failure of conservative management can lead to prolonged upper airway obstruction (UAO) and potential complications.

Purpose of the Study:

  • To compare infants with RS managed conservatively alone versus those requiring surgical intervention.
  • To identify predictive factors for the failure of conservative airway management in RS.
  • To potentially expedite definitive treatment for infants with severe UAO.

Main Methods:

  • Retrospective review of a prospectively gathered database of 122 infants with RS.
  • Comparison of demographic, nutritional, respiratory, and polysomnographic data between successful conservative management (Group 1) and surgical intervention (Group 2) groups.
  • Receiver operating characteristic (ROC) curve analysis to identify predictive variables for conservative management failure.

Main Results:

  • Several variables differed significantly between groups.
  • Specific polysomnographic findings, termed 'EARN' factors, were highly predictive of failed conservative management:
  • End-tidal CO2 (max) > 49 mmHg, Apnea-Hypopnea Index (AHI) > 16.9 events/hour, Obstructive Apnea-Hypopnea Index (OAHI) during REM > 25.9 events/hour, and OAHI during Non-REM > 23.6 events/hour.

Conclusions:

  • Identified specific polysomnographic factors (EARN) associated with severe UAO in infants with RS.
  • These factors indicate a poor prognosis with conservative airway management alone.
  • Early identification using these predictors may facilitate timely surgical intervention, reducing risks associated with prolonged UAO.

Keywords:
MDOTLApolysomnogramrobin sequencetracheostomyupper airway obstruction

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