title: Functional treatment of airway obstruction and feeding problems in infants with Robin sequence.
abstract: BACKGROUND
  Robin sequence (RS), characterised by micrognathia/retrognathia and glossoptosis with or without cleft palate, presents with intermittent upper airway obstruction and feeding difficulties. Active intervention is required to reduce the risk of brain damage or sudden death. Most treatment options are poorly studied and/or invasive. Our group developed a functional approach including early feeding training and the pre-epiglottic baton plate (PEBP), an orthodontic appliance with a velar extension shifting the base of the tongue forward.
  
  
  METHODS
  We evaluated the effect of this approach on sleep study results and early weight gain by searching our electronic patient database for infants with isolated RS, born at or referred to our department between 1 January 2003 and 31 December 2012 and treated with the PEBP.
  
  
  RESULTS
  Of 122 patients identified, 360 overnight sleep study results, obtained at admission, prior to hospital discharge and 3 months postdischarge, were available (117 infants had complete data). These showed a decrease in the mixed-obstructive apnoea index from (median; IQR) 8.8 (2.1-19.7) to 1.8 (0.6-5.4); p<0.001 and 0.2 (0-1.3); p<0.001, respectively. Z-scores for weight improved from -0.7 (-1.39 to -0.24) upon admission to -0.5 (-0.90 to +0.02) at follow-up (p=0.02), accompanied by a decrease in the proportion of infants requiring nasogastric tube feeding from 66% to 8%. No infant required craniofacial surgery or tracheostomy.
  
  
  CONCLUSIONS
  These longitudinal cohort data suggest that this functional approach may be an option to treat both, upper airway obstruction and feeding problems, in infants with isolated RS.
authors.affiliation: Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Buchenau
authors.affiliation: Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wenzel
authors.affiliation: BIP-Orthodontic Practice, Tübingen, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Bacher
authors.affiliation: Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Müller-Hagedorn
authors.affiliation: Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Arand
authors.affiliation: Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.|Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Poets
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D018529:Nutritional Support / Q000379:methods; D009970:Orthodontics / Q000379:methods; D010855:Pierre Robin Syndrome / Q000150:complications / Q000628:therapy*; D017286:Polysomnography; D012189:Retrospective Studies; D012890:Sleep
keywords: failure to thrive; feeding problems; obstructive sleep apnea