Clinical experience with infants with Robin sequence: a prospective study.
OBJECTIVE
To study the clinical course of patients with Robin sequence (RS) during the first 6 months of life.


METHODS
A longitudinal prospective study of children with RS.


METHODS
Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru-SP, Brazil, 1997 and 1998.


METHODS
Sixty-two children were studied from hospital admission to 6 months of age. Thirty-three (53.2%) presented with probable isolated RS (PIRS), 25 (40.3%) presented with syndromes or other malformations associated with RS, and 4 (6.5%) presented with RS with neurological involvement.


METHODS
The type of respiratory tract obstruction was defined by nasopharyngoscopy. The patients with type 1 and type 2 obstruction underwent nasopharyngeal intubation (NPI), and glossopexy was indicated in patients with type 1 obstruction who did not show clinical improvement with this procedure. Tracheostomy was indicated in patients with type 2 obstruction who did not show a good course after NPI, in patients with type 1 obstruction who did not show good course after glossopexy, and in patients with type 3 and type 4 obstruction.


RESULTS
Prone position treatment (PPT) or NPI was the definitive treatment in 25 cases (75.8%) of PIRS and in 13 cases (52%) of syndromes or other malformations. Among the children with type 1 obstruction, 24 (51.1%) were submitted exclusively to PPT and 12 (25.5%) to NPI. With the type 2 groups, only one (12.5%) received PPT, and three (37.5%) were treated exclusively with NPI. All 15 infants treated exclusively with NPI (24.4%) presented with good weight, length, and neuromotor development.


CONCLUSIONS
Most patients with PIRS and type 1 obstruction improved without surgical intervention. NPI should be the initial treatment in all patients with RS with type 1 and type 2 obstruction who present with important respiratory and feeding difficulties.
Marques
I L
IL
Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo, Bauru, SP, Brazil. ilza_marques@uol.com.br
de Sousa
T V
TV
Carneiro
A F
AF
Barbieri
M A
MA
Bettiol
H
H
Gutierrez
M R
MR
D000015:Abnormalities, Multiple; D000402:Airway Obstruction / Q000145:classification / Q000503:physiopathology* / Q000628:therapy; D001827:Body Height; D001835:Body Weight; D002657:Child Development; D004724:Endoscopy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008137:Longitudinal Studies; D009305:Nasopharynx; D010855:Pierre Robin Syndrome / Q000145:classification / Q000503:physiopathology* / Q000628:therapy; D016684:Prone Position; D011446:Prospective Studies; D015996:Survival Rate; D014059:Tongue / Q000601:surgery; D014139:Tracheostomy; D016896:Treatment Outcome