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Conservative Airway Management Successful in Majority of Infants With Pierre-Robin Sequence at Queensland Children's
Harrison Theile1, Yun Phua1, Stuart Bade1
1Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia.
Insights
Most children with Pierre-Robin Sequence (PRS) achieve successful airway management without surgery, primarily using nasopharyngeal airways. This study highlights a conservative approach for PRS airway obstruction.
Area of Science:
- Pediatric Surgery
- Neonatology
- Craniofacial Anomalies
Background:
- Pierre-Robin Sequence (PRS) presents with micrognathia, glossoptosis, and airway obstruction.
- Current management algorithms for PRS lack clear surgical versus nonsurgical intervention guidelines.
Purpose of the Study:
- To review the management strategies for children diagnosed with Pierre-Robin Sequence in Queensland.
- To evaluate the effectiveness of surgical and nonsurgical interventions for airway obstruction in PRS.
Main Methods:
- Retrospective review of 45 children diagnosed with PRS from April 2014 to October 2019.
- Categorization of management into prone/lateral positioning, nasopharyngeal airway (NPA) use, and surgical intervention.
Main Results:
- 67% of children were successfully managed non-surgically with an NPA; 40% required supplemental oxygen.
- 77% of the remaining children were managed with positioning alone or with adjuncts; only 2 patients required surgery.
- Feeding supplementation via nasogastric tube was necessary in 78% of patients; cleft palate was present in all but one patient.
Conclusions:
- 96% of PRS children in this cohort were managed without surgery, indicating a high success rate for conservative measures.
- Management strategies for PRS airway obstruction vary, suggesting a need for careful consideration before surgical intervention.
- Findings may challenge existing literature and support a less invasive approach for PRS airway management.
Purpose:
Pierre-Robin Sequence (PRS) is a congenital abnormality characterized by micrognathia, glossoptosis, and variable severity upper airway obstruction. Clear management algorithms are lacking, particularly the indications for surgical versus nonsurgical intervention. The authors reviewed the management of these children in Queensland.
Methods:
All children diagnosed with PRS at Queensland Children's Hospital from April 2014 to October 2019 were identified (n=45), and their charts were retrospectively reviewed. Three management patterns emerged: prone/lateral positioning, nasopharyngeal airway (NPA) use, and surgery (tracheostomy or mandibular distraction).
Results:
Most children (n=30; 67%) were managed successfully nonsurgically with an NPA (median age of insertion 0.25 mo, median duration 5.0 mo). Of these, 12 patients (40%) also required supplemental oxygen. The median age of NPA cessation was 5.5 months, with oxygen therapy ceasing at a median 8.25 months, upon which no further support was required. The remaining majority (n=13; 29%) of children were managed without an NPA, using positioning alone (10/13; 77%) or positioning combined with supplemental oxygen (1/13), CPAP (1/13), or both adjunct measures (1/13). Only 2 patients underwent surgical intervention. Feeding supplementation using nasogastric tube was necessary in 78% of patients for a median duration of 4 months. Cleft palate co-existed in all but one patient.
Conclusion:
Management of upper airway obstruction in PRS children is variable between units. Over a 5-year period, 96% of children with PRS were successfully managed without surgical intervention at the Queensland Children's Hospital. These findings contrast with some other literature and may suggest that more careful consideration of surgical intervention in PRS patients is prudent.
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