Nutritional Needs and Growth Patterns in Patients With Robin Sequence Following Mandibular Distraction Osteogenesis

Mandibular distraction osteogenesis (MDO) treats airway obstruction in patients with Robin sequence (RS). The management of respiratory distress, in addition to disrupted oral motor function secondary to mandibular hypoplasia, often results in delayed nutritional optimization. In this study, we evaluate predictors of nutritional supplementation, timing to oral intake, and weight gain in patients with RS following MDO.

A retrospective review was conducted of RS patients who underwent MDO at a tertiary children's hospital from 2004 to 2022. Demographics, syndromic diagnoses, and feeding routes were collected. Patients were grouped into syndromic Robin sequence (sRS) and isolated Robin sequence (iRS) cohorts. The primary outcomes were G-tube placement and time to full oral intake. Secondary outcomes included weight-for-length (WFL) percentiles and expected average daily weight gain (ADWG), calculated from the nearest standardized growth curve.

Of 144 patients who underwent MDO, 94 met the inclusion criteria (20 sRS, 74 iRS). The median corrected gestational age was 1.0 month at time of MDO surgery. Overall, 41.5% received a G-tube within the study period. Full oral intake was achieved at a median of 39 days post-MDO. Patients with sRS required more time to achieve full oral intake than those with iRS (55 days vs 37 days, P = 0.039). Multivariable logistic regression revealed greater odds of G-tube placement in patients with sRS ( P = 0.011) and those born preterm ( P = 0.002). Initial mean WFL percentiles decreased from birth to time of MDO but increased to above 50th percentile by 12 months post-MDO. At 12 months post-MDO, the sRS cohort had significantly lower mean WFL percentiles ( P = 0.001). Despite this, the ADWG percent differences did not vary between sRS and iRS cohorts from MDO to 12 months postoperatively ( P = 0.49).

Patients with RS who underwent MDO demonstrated improvement in oral intake and demonstrated steady weight gain postoperatively. Patients with sRS and preterm birth had greater G-tube requirements and required more time to achieve full oral intake. Patients with sRS exhibited lower WFL percentiles postoperatively but also surpassed expected weight gain when compared to those with iRS. Ultimately, tailored postoperative nutrition plans and close monitoring are critical for high-risk patients, particularly those with syndromic RS.