Experience in Management of Airway Obstruction and Feeding Difficulties of Cleft Palate Infants with Pierre Robin Sequence

yPurposes, Subjects and MethodszA retrospective study was conducted to review the management of airway obstruction (AO) and feeding difficulties (FD) of cleft palate infants with Pierre Robin sequence (PRS), who treated at our department, Oita University Hospital between 1981 and 2013. In addition, risk factors related with complications immediately after palatoplasty were analyzed. Data were collected from patient’s files of Oita Univ. Hospital.

yResultszTwenty-eight infants were included in this study, 15 males and 13 females. Diagnosis of PRS was made by pediatricians of our hospital. Eighteen infants had isolated PRS with cleft palate. Ten infants had PRS without known syndromes, but had associated anomalies other than micrognathia and cleft palate. The degree of PRS was categolized as mild in 6 cases, moderate in 4 and severe in 18 according to the Monroe’s classification. Out of 28 infants, 11 had both of AO and FD, 10 had FD alone, and 7 had none of them. All 18 severe PRS cases had AO and/or FD, while 6 mild PRS cases had none. Eleven infants with AO were required interventions; endotracheal intubation in 6, nasopharyngeal airway (NPA) in 2 and positioning in 3. One infant, who received endotracheal intubation, transferred to a different hospital and underwent tracheotomy there. Twenty-one infants with FD required nasogastric (NG) feeding, and mean duration of MG feeding was 3.5 months (range 10 days to 12 months). As for palatoplasty, 23 out of 28 infants underwent surgery at our department, and 2 at other hospitals. No information about palatoplasty was obtained in remaining 3 infants because of loss of follow-up. Out of 23 infants who received surgery at our department, 5 had postoperative airway obstruction, necessitating NPA insertion for 1-6 days after operations. These 5 cases were categorized as severe PRS in 4 and moderate PRS in 1, and 4 of them had both of AO and FD in the neonate period.

yConclusionszIn our experience, conservative management of airway and feeding can be accomplished in all the PRS infants, and no surgical procedures such as tracheotomy and gastrostomy tube were carried out during the period of follow-up at our hospital . In PRS infants who had AO and FD in the neonate period, airway obstruction after palatoplasty should be taken into consideration as a postoperative complication.

yReferencesz

1.Glynn F. et al. Pierre Robin sequence: an institutional experience in the multidisciplinary management of airway, feeding and serous otitis media challenges.Int J pediatr Otorhinolaryngol 75(2011) 1152-1155

2.Monroe CW and Ogo K Treatment of micrognathia in the neonatal period. Report of 65 cases. Plast Reconstr Surg 50(1972) 317-325