title: Airway management for intubation in newborns with Pierre Robin sequence.
abstract: OBJECTIVE
  To review airway management in Pierre Robin sequence (PRS) newborns undergoing general anesthesia and to determine if endotracheal intubation is safe in this population.
  
  
  METHODS
  Case series and retrospective chart review at a tertiary children's hospital.
  
  
  METHODS
  PRS newborns who underwent endotracheal intubation or other airway intervention before 3 months of age between January 2000 and July 2011 were identified from a pediatric otolaryngology practice database. Indications for airway intervention, anesthetic management, method of intubation, and comorbid conditions were collected.
  
  
  RESULTS
  Thirty-three PRS newborns were identified. Twenty had isolated PRS, and 13 had PRS related to a coexisting syndrome. Thirteen of 35 (37%) endotracheal intubations performed in PRS newborns prior to mandibular distraction osteogenesis were accomplished with direct laryngoscopy. The remaining 22 of 35 (63%) who failed intubation with direct laryngoscopy were intubated over a flexible fiberoptic bronchoscope. No significant difference was observed between the isolated and syndromic PRS newborns with regard to technique utilized for intubation. No patient required rescue laryngeal mask airway or emergent tracheotomy, and no case resulted in death.
  
  
  CONCLUSIONS
  This series demonstrates that endotracheal intubation is safe and effective in PRS newborns. In patients who failed intubation with direct laryngoscopy, intubation over a flexible fiberoptic bronchoscope provided a reliable alternative method. Although airway management in PRS newborns poses a significant challenge, experienced otolaryngologists and anesthesiologists can successfully manage these difficult airway cases.
authors.affiliation: Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Marston
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Lander
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tibesar
authors.forename: James D
authors.initials: JD
authors.lastname: Sidman
mesh_terms: D058109:Airway Management / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods; D010855:Pierre Robin Syndrome / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016896:Treatment Outcome