title: A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm.
abstract: OBJECTIVE
  Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution's approach and a review of the current literature.
  
  
  METHODS
  A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996-2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS.
  
  
  RESULTS
  Forty-four infants (59%) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25%, p = .014). A mandibular distraction was conducted in 24% (n = 18) of cases, a tracheotomy in 9% (n = 7), and a tongue-lip adhesion in 8% (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described.
  
  
  CONCLUSIONS
  RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended.
  
  
  CONCLUSIONS
  We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands. emmapaes@gmail.com.|Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. emmapaes@gmail.com.
authors: Emma C
authors: EC
authors: Paes
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Daan P F
authors: DP
authors: van Nunen
authors: Department of Otorhinolaryngology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Lucienne
authors: L
authors: Speleman
authors: Department of Oral and Cranio-Maxillofacial Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Marvick S M
authors: MS
authors: Muradin
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Bram
authors: B
authors: Smarius
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Moshe
authors: M
authors: Kon
authors: Aebele B
authors: AB
authors: Mink van der Molen
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Aebele B Mink
authors: AB
authors: van der Molen
authors: Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Titia L E M
authors: TL
authors: Niers
authors: Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Esther S
authors: ES
authors: Veldhoen
authors: Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Corstiaan C
authors: CC
authors: Breugem
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010855:Pierre Robin Syndrome / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies
keywords: Approach; Mandibular distraction; Multidisciplinary team; Pierre Robin; Tongue–lip adhesion; Tracheotomy; Treatment