A Sedation Protocol for Endoscopic Baton-Plate Adjustment in Neonates With Pierre Robin Sequence

Robin sequence (RS) is characterized by upper airway obstruction leading to life-threatening desaturations in neonates. Procedural sedation in this population presents unique challenges due to anatomical airway anomalies, young patient age, and associated comorbidities. The pre-epiglottic baton-plate (PEBP) procedure is a non-invasive, endoscopically guided intervention that alleviates obstruction, facilitates oral feeding, and promotes mandibular growth. Sedation for PEBP adjustment requires the maintenance of spontaneous respiration while ensuring patient comfort and procedural tolerance.

To compare process characteristics and observed adverse events before and after an institutional change in the sedation regimen and staffing model for endoscopic PEBP adjustment in neonates with RS.

This retrospective single-center cohort study included 18 infants undergoing endoscopic PEBP adjustment between December 2012 and June 2025. Cohort I (n = 8) received individualized sedation, most commonly propofol with remifentanil, with variable personnel present. Cohort II (n = 10) received sevoflurane induction followed by ketamine and dexmedetomidine for maintenance, with predefined interdisciplinary staffing including two senior anesthesiologists. Demographic data, sedation regimens, sedation-related adverse events, and airway interventions were compared between groups.

All 18 procedures were completed successfully. A total of five sedation-related adverse events occurred, four in Cohort I and one in Cohort II. All events were managed effectively with routine measures. No patient required conversion to general anesthesia or invasive airway management. Procedural duration was significantly shorter in Cohort II. Baseline, lowest intraoperative, and first postoperative oxygen saturation did not differ significantly.

Standardization of sedation protocols and procedural workflows was associated with shorter procedure times and fewer observed adverse events; however, the small sample size (n = 8 and n = 10) precludes conclusions regarding safety or causality. In rare, high-risk neonatal procedures, structured and interprofessional approaches may help reduce variability and support reproducible care.