title: Neonatal Micrognathia: National Trends in Early Mandibular Surgery.
abstract: BACKGROUND
  Micrognathia is a congenital anomaly that may pose breathing and feeding limitations in newborns, sometimes necessitating invasive management. The present study aims to identify the complications associated with receiving mandibular surgery during the birth stay in order to better predict which patients may benefit from early surgical intervention.
  
  
  METHODS
  A retrospective cohort study was performed using the 2000 to 2012 kids' inpatient databases. We included all live newborn infants born in the hospital through vaginal delivery or caesarean section. We used multivariate logistic regression to investigate the demographic and clinical factors associated with receiving mandibular surgery for micrognathia during the birth stay.
  
  
  RESULTS
  Of 19,638,453 births, 999 were diagnosed with micrognathia (0.005%). Forty (4%) patients with micrognathia underwent mandibular surgery during the initial admission. On univariate analysis in newborns with micrognathia, mandibular surgery during birth stay was associated with cleft palate, apnea, intubation, tracheostomy, obstructive sleep apnea (OSA), and long mechanical ventilation. Multivariate analysis supported the association between mandibular surgery during the initial admission and long mechanical ventilation (odds ratio [OR], 24.6; 95% confidence interval [CI], 7.7-78.5), OSA (OR, 24.9; 95% CI, 2.5-261.8), apnea (OR, 4.2; 95% CI, 1.5-11.3), and cleft palate (OR, 4.6; 95% CI, 2.0-10.6). However, intubation and tracheostomy were not found to be associated with early mandibular surgery during the birth stay.
  
  
  CONCLUSIONS
  The present study identified long mechanical ventilation, apnea, cleft palate, and OSA as factors indicating patients who may benefit from early mandibular surgery, such as mandibular distraction osteogenesis. These findings may bring the clinician closer to standardizing the indications for early mandibular distraction osteogenesis.
authors.affiliation: From the Mount Sinai Cleft and Craniofacial Center, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY.
authors.forename: Hillary E
authors.initials: HE
authors.lastname: Jenny
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Massenburg
authors.forename: E Hope
authors.initials: EH
authors.lastname: Weissler
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D008844:Micrognathism / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000706:statistics & numerical data / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States