title: Predicting surgical intervention for airway obstruction in micrognathic infants.
abstract: OBJECTIVE
  To determine which factors present in the neonatal period may predict subsequent need for surgical intervention in infants with micrognathia.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Two, urban, tertiary pediatric hospitals.
  
  
  METHODS
  The otolaryngology databases from 2 institutions were queried for the diagnosis of micrognathia over a 10-year period, and 123 infants were identified (101 with Pierre Robin sequence and 21 with micrognathia without cleft palate). The presence or absence of surgical airway intervention during the first year of life was noted, as were associated diagnoses. Univariate and multivariate analyses were performed to identify risk factors for requiring a definitive airway intervention.
  
  
  RESULTS
  Forty-eight (39%) micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of either tracheostomy (12 patients), mandibular distraction osteogenesis (MDO; 33 patients) or prolonged intubation prior to death (3 patients). Factors associated with a need for intervention included a history of intubation or tracheotomy in the first 24 hours of life (odds ratio [OR], 8.22; confidence interval [CI], 3.14-21.53), a history of intrauterine growth restriction (OR, 4.10; CI, 1.00-16.70), prematurity (<37 weeks of gestational age; OR, 2.38; CI, 1.02-5.56), and neurologic impairment (OR, 3.83; CI, 1.33-11.07). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR, 0.20; CI, 0.05-0.71).
  
  
  CONCLUSIONS
  While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors that may predict which neonates with micrognathia are at increased risk for meriting early surgical intervention for respiratory and feeding problems.
authors: University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors: Sara C
authors: SC
authors: Handley
authors: Nicholas S
authors: NS
authors: Mader
authors: James D
authors: JD
authors: Sidman
authors: Andrew R
authors: AR
authors: Scott
mesh_terms: D000402:Airway Obstruction / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D008334:Mandible / Q000601:surgery; D008844:Micrognathism / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000601:surgery*; D012307:Risk Factors; D014139:Tracheostomy