Resolving Feeding Difficulties With Early Airway Intervention in Pierre Robin Sequence

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Abstract
Objectives/Hypothesis: To observe rates of gastrostomy tube (g‐tube) placement in Pierre Robin Sequence (PRS) and to determine whether relieving airway obstruction solves feeding difficulties.Study Design: All PRS referrals to a multidisciplinary cleft team for children at a tertiary pediatric hospital from January 1988 to June 2006 were retrospectively reviewed.Methods: Patients were analyzed for occurrence of g‐tube placement, neurologic disorders, and airway intervention including tracheotomy and mandibular distraction osteogenesis.Results: Sixty‐seven PRS patients were divided into two categories: 51 (76.1%) isolated PRS (iPRS) and 16 (23.9%) with additional disorders and syndromes (sPRS). Patients were then placed into two subgroups: those who received early airway intervention and those who received late or no airway intervention. Of the 51 iPRS children, 12 (23.5%) received early airway intervention, none of whom required a g‐tube. There were 39 (76.5%) children who received late or no airway intervention, and 5 (12.8%) of these required g‐tube placement. Of the 16 sPRS children, 8 (50%) received early airway intervention, and 7 (87.5%) of these still required a g‐tube. Of the remaining 8 (50%) sPRS patients who received late or no airway intervention, 5 (62.5%) required a g‐tube.Conclusion: In children with iPRS, feeding difficulties can be resolved with early airway intervention. Delaying airway intervention may necessitate feeding assistance because all of the iPRS children who required a g‐tube fell into this category. The presence of additional disorders and syndromes further complicates treatment because most of the sPRS children required g‐tubes regardless of airway intervention.

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