Back to 2014 Annual Meeting Abstracts

BACKGROUND:
Indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction are not well-defined. The goal of this study was to identify the clinical features and objective findings for patients with RS whose airways were successfully managed without surgical intervention in a neonatal intensive care unit (NICU) at a tertiary center.
METHODS:
The authors retrospectively reviewed medical charts for all infants diagnosed with RS who were admitted to the NICU at a single institution from 1994 through 2010. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) were recorded. Only patients who successfully maintained their airway without surgical intervention were included.
RESULTS:
Twenty-six infants were identified. The average hospital stay was 14.6 days (range 5-70). Oxygen desaturations, below 70% by pulse oximetry, were spontaneous (65%) or associated with feeding (42%) and sleeping (27%). All patients required at least temporary oxygen supplementation by nasal cannula (50%), endotracheal intubation (23%), nasopharyngeal oxygenation (15%), or high-flow supplementation (12%). Eighty-five percent of patients required a temporary nasogastric tube for nutritional support during hospitalization but no surgical feeding tubes were placed. PSG data (N=13) demonstrated mild to moderate obstruction, a mean apnea-hypopnea index (AHI) of 19.2 (+/-5.3) events/hour, and four percent of total sleep time with an O2 saturation less than 90%.
CONCLUSIONS:
Nonsurgical airway management was successful in patients who demonstrated adequate weight gain and mild to moderate obstruction on PSG. These characteristics may help predict the efficacy of conservative airway management in patients with severe RS who are admitted to the NICU.