Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases

• Published in: The Cleft palate-craniofacial journal Vol. 59; no. 7; pp. 891 - 898
• Main Authors: Blanc, Fabian, Harrewijn, Inge, Duflos, Claire, Maggiulli, Frederica, Captier, Guillaume
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-07-2022; SAGE PUBLICATIONS, INC; American Cleft Palate-craniofacial Association
• Subjects: Airway management; Birth defects; Childrens health; Human health and pathology; Life Sciences; Pediatrics; Surgery; cleft palate; upper airway obstruction; nasopharyngeal tube; respiratory distress; Pierre Robin sequence; Nasopharyngeal tube; Respiratory distress; Cleft palate; Upper airway obstruction
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1177/10556656211031105

Objectives:
To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders.
Design:
A retrospective single-center study of 150 children with PRS.
Setting:
Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS.
Patients:
A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment.
Main outcome measures:
Evolution and results of the initial treatment of PRS.
Results:
Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children.
Conclusions:
Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.