title: Neonates with tongue-based airway obstruction: a systematic review.
abstract: OBJECTIVE
  In this systematic review, the authors summarize the current evidence in the literature regarding diagnosis, treatment, and long-term outcomes in neonates with tongue-based airway obstruction (TBAO) and assess the level of evidence of included studies.
  
  
  METHODS
  The terms Pierre Robin syndrome/sequence, micrognathia, retrognathia, and cleft palate were combined with airway obstruction, treatment, tongue-lip plication, and osteogenesis distraction to perform an Ovid literature search, yielding 341 references. The authors excluded references containing patients with isolated choanal/nasal obstruction, patients older than 12 months, and expert opinion papers, yielding 126 articles.
  
  
  METHODS
  The authors searched 3 electronic databases and reference lists of existing reviews from 1980 to October 2010 for articles pertaining to the diagnosis, treatment, and outcomes of TBAO. Reviewers assigned a level of evidence score based on Oxford's Centre for Evidence Based Medicine scoring system and recorded relevant information.
  
  
  RESULTS
  Most studies were case studies and single-center findings. The lack of standardization of diagnostic and treatment protocols and the heterogeneity of cohorts both within and between studies precluded a meta-analysis. There was little evidence beyond expert opinion and single-center evaluation regarding diagnosis, treatment, and long-term outcomes of neonates with TBAO.
  
  
  CONCLUSIONS
  The variability in the phenotype of the cohorts studied and the absence of standardized indications for intervention preclude deriving any definitive conclusions regarding diagnostic tools to evaluate this patient population, treatment choices, or long-term outcomes. A coordinated multicenter study with a standardized diagnostic and treatment algorithm is recommended to develop evidence for the diagnosis and treatment of neonates with TBAO.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. laurel.bookman@cchmc.org
authors.forename: Laurel B
authors.initials: LB
authors.lastname: Bookman
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Melton
authors.forename: Brian S
authors.initials: BS
authors.lastname: Pan
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Bender
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Chini
authors.forename: James M
authors.initials: JM
authors.lastname: Greenberg
authors.forename: Howard M
authors.initials: HM
authors.lastname: Saal
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Ravindhra G
authors.initials: RG
authors.lastname: Elluru
mesh_terms: D000402:Airway Obstruction / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D014059:Tongue / Q000002:abnormalities* / Q000601:surgery