title: Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study.
abstract: OBJECTIVE
  In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies.
  
  
  METHODS
  A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients.
  
  
  RESULTS
  RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47-100 %), and 55 % (range = 11-100 %) of infants need NG-tube feeding.
  
  
  CONCLUSIONS
  FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up.
  
  
  CONCLUSIONS
  This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands. emmapaes@gmail.com.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Paes
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Iris A C
authors.initials: IAC
authors.lastname: de Vries
authors.affiliation: Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Wouter M
authors.initials: WM
authors.lastname: Penris
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Karlijn H
authors.initials: KH
authors.lastname: Hanny
authors.affiliation: Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Selma W
authors.initials: SW
authors.lastname: Lavrijsen
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Elselien K
authors.initials: EK
authors.lastname: van Leerdam
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Maaike M
authors.initials: MM
authors.lastname: Rademaker
authors.affiliation: Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Veldhoen
authors.affiliation: Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Rene M J C
authors.initials: RMJC
authors.lastname: Eijkemans
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.|Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
mesh_terms: D002657:Child Development; D002971:Cleft Lip / Q000503:physiopathology; D002972:Cleft Palate / Q000503:physiopathology; D001068:Feeding and Eating Disorders / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010855:Pierre Robin Syndrome / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: (Pierre) Robin sequence; Cleft palate; Feeding difficulties; Growth; Systematic review; Treatment; Weight