The Northeastern Society of Plastic Surgeons

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Apnea-hypopnea index does not correlate with weight gain or failure to thrive in neonates with Robin sequence
Erin M. Rada, M.D.1, Lauren Salinero1, David Zurakowski, Ph.D.2, Gary F. Rogers, M.D.1, Albert K. Oh, M.D.1.
1Children's National Health System, Washington, DC, USA, 2Boston Children's Hospital, Boston, MA, USA.

BACKGROUND: In patients with Robin sequence (RS), indications for surgical airway intervention are unclear, but the decision is broadly based upon respiratory obstruction and, ultimately, failure to thrive (FTT). Results of polysomnography (PSG) including apnea-hypopnea index (AHI), and weight gain have been traditionally used as proxies for these clinical outcomes, but the relationship between these parameters has not been studied.
METHODS: This was a retrospective study of all patients with a diagnosis of RS treated at our institution from 1994 to 2017. Inclusion criteria included nonsyndromic patients with PSG data and serial weight measurements prior to either surgical intervention or discharge. FTT was defined as weight gain of <30 g/day after at least one week of conservative management.
RESULTS: In the 31 patients who met inclusion criteria, AHI showed no significant correlation with average daily weight gain (r=0.25, p=0.17). Furthermore, patients with FTT actually had lower mean AHI than those without FTT, though these differences were not statistically significant (4945 vs. 8037, p=0.14). Dropping the threshold for defining FTT to <25 g/day of weight gain yielded similar results, with mean AHI in FTT vs. non-FTT of 5148 vs. 6338 (p=0.47)
CONCLUSIONS: Despite widespread use of AHI to quantify severity of upper airway obstruction in neonates with RS, this small study failed to demonstrate any significant correlations between AHI and mean weight gain or FTT. Larger studies should be done to further investigate these findings and determine any long-term clinical significance.


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