Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study

• Published in: The Cleft palate-craniofacial journal 2023-09, Vol.62 (1), p.51-62
• Main Authors: van der Plas, Pleun P.J.M., van Heesch, Gwen G.M., Koudstaal, Maarten J., Pullens, Bas, Mathijssen, Irene M.J., Bernard, Simone E., Wolvius, Eppo B., Joosten, Koen F.M.
• Format: Article
• Language: English
• Subjects: Airway management; Birth defects; Clinical outcomes; Dysphagia; Morphology; Mouth; Original; Pediatrics
• ISSN: 1055-6656; 1545-1569; 1545-1569
• DOI: 10.1177/10556656231199840

Objective To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. Design Prospective study. Setting Sophia Children's Hospital, Rotterdam, the Netherlands. Patients/ Participants 36 patients with Robin Sequence who were treated between 2011 and 2021. Interventions Positional therapy and respiratory support. Main Outcome Measure(s) Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). Results Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from −0.40 to −0.33 to −1.03, respectively. Conclusions Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.