Resolving feeding difficulties with early airway intervention in Pierre Robin Sequence.
OBJECTIVE
To observe rates of gastrostomy tube (g-tube) placement in Pierre Robin Sequence (PRS) and to determine whether relieving airway obstruction solves feeding difficulties.


METHODS
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.


CONCLUSIONS
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.
Lidsky
Michael E
ME
Georgetown University School of Medicine, Washington, D.C., U.S.A.
Lander
Timothy A
TA
Sidman
James D
JD
D000402:Airway Obstruction / Q000517:prevention & control*; D002648:Child; D004750:Enteral Nutrition / Q000295:instrumentation; D001068:Feeding and Eating Disorders / Q000517:prevention & control*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D008334:Mandible / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000379:methods; D010855:Pierre Robin Syndrome / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D014140:Tracheotomy