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The challenge of assessing upper airway obstruction severity in infants with Robin Sequence
Lucie Genet1, Sonia Khirani2, Nancy Vegas1
1Pediatric Department, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France.
Insights
Assessing upper airway obstruction (UAO) in infants with Robin Sequence (RS) is challenging. Clinical scores and respiratory polygraphy (PG) parameters showed limited correlation, suggesting a need for more comprehensive evaluation methods.
Area of Science:
- Pediatrics
- Neonatology
- Respiratory Medicine
Background:
- Infants with Robin Sequence (RS) face a high risk of upper airway obstruction (UAO).
- Accurate assessment of UAO severity is crucial for timely intervention.
- Current evaluation methods may not fully capture the complexity of UAO in RS.
Purpose of the Study:
- To compare the severity of UAO using a clinical score, mixed and obstructive apnea-hypopnea index (MOAHI), and oxygen desaturation index (ODI) via respiratory polygraphy (PG).
- To evaluate the correlation between these parameters and the need for non-invasive respiratory support (NIRS).
Main Methods:
- Retrospective analysis of data from 43 infants with RS.
- Evaluation of clinical severity scores (0-3), MOAHI (events/hour), and ODI (events/hour).
- Correlation analysis between clinical scores, MOAHI, ODI, and NIRS initiation.
Main Results:
- A significant correlation was found only between MOAHI and ODI (r=0.549, p<0.001).
- Clinical severity scores showed limited correlation with PG parameters.
- No correlation was observed between UAO parameters and NIRS initiation in infants who required it.
Conclusions:
- Assessing UAO severity in infants with RS using clinical evaluation and standard PG parameters is difficult.
- A comprehensive approach integrating body position, sleep/wake state, and hypoxic burden is recommended for accurate UAO assessment in RS infants.
Abstract:
Infants with Robin Sequence (PS) at high risk of upper airway obstruction (UAO). The aim of our study was to compare the severity of UAO evaluated on a 3-level clinical score, the mixed and obstructive apnea-hypopnea index (MOAHI), and the 3 % oxygen desaturation index (ODI) on a respiratory polygraphy (PG). The second aim was to compare the indication for a non-invasive respiratory support (NIRS), based on the severity of UAO using the same criteria. Severe clinical UAO was defined as a clinical score of 2 or 3, severe MOAHI as a value ≥ 10 events/hour and severe ODI as a value ≥ 10 events/hour. The data of 43 infants, mean age 2.3 ± 1.1 months, were analysed. Seventeen (40 %) and 10 (23 %) infants had a clinical severity score of 2 or 3, respectively. Eleven (26 %) infants had a MOAHI ≥ 10 events/hour and 22 (52 %) an ODI ≥ 10 events/hour. When analysing the correlation between these 3 parameters, only the MOAHI correlated with the ODI (r = 0.549, p < 0.001). Regarding NIRS initiation, no correlation was observed between any of the 3 parameters in the 18 infants who required a NIRS. In conclusion, this study shows the difficulty to assess the severity of UAO in infants with RS taking in account a clinical evaluation and two PG respiratory parameters. This pleads for the integration of body position and sleep/wake state, as well as other respiratory parameters, such as the hypoxic burden, for the assessment of UAO severity in infants with RS.
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