Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

Kam, Karen; McKay, Meghan; MacLean, Joanna E.; Witmans, Manisha; Spier, Sheldon; Mitchell, Ian C.

doi:10.1155/2015/798076

Cited by 22 publications

(15 citation statements)

References 30 publications

(30 reference statements)

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“…UAO assessments were made clinically, and in cases where clinical assessment was unclear or equivocal a sleep study (limited channel cardio‐respiratory polygraphy) was carried out. The requirement for active airway management in 63% of cases is comparable to reports from numerous studies of RS management across many different settings and populations, again suggesting that infants in our cohort had “true” and clinically significant RS.…”

Section: Discussionsupporting

confidence: 82%

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Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013

Wright

Mehendale

Urquhart

2018

Pediatric Pulmonology

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Section: Discussionsupporting

confidence: 82%

“…The requirement for active airway management in 63% of cases is comparable to reports from numerous studies of RS management across many different settings and populations, [14][15][16][17] again suggesting that infants in our cohort had "true" and clinically significant RS.…”

Section: Discussionsupporting

confidence: 81%

Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013

Wright

Mehendale

Urquhart

2018

Pediatric Pulmonology

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“…No studies addressed survival outcomes in infants with PRS using long-term NIV. Adherence of infants to NIV was reported as excellent, showing more than 8 hours of NIV use per day in two studies ( 31 , 36 ), with only a 1–2 week period required to adjust to the mask ventilation ( 31 , 35 ). An additional cohort study demonstrated that infants with PRS using NIV were 10.43 times more likely to progress to a surgical airway compared to infants who required less advanced respiratory supports such as prone positioning and a nasopharyngeal airway ( 34 ).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies on 16 infants with PRS reported discontinuation from NIV in 11 (69%) infants because of improvements in respiratory parameters ( 31 , 36 ). Two studies comparing infants on NIV and invasive mechanical ventilation showed that the length of hospitalization were shorter for infants on NIV than for those receiving invasive mechanical ventilation via a tracheostomy (Table 4 ) ( 31 , 35 ). No studies addressed survival outcomes in infants with PRS using long-term NIV.…”

Section: Resultsmentioning

confidence: 99%

Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis

et al. 2018

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BackgroundThe use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants.MethodsOvid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library were systematically searched from January 1990 to July 2017. Studies on infants using long-term NIV outside of an acute care setting were included. Data were extracted on study design, population characteristics, and NIV outcomes.ResultsA total of 327 studies were full-text reviewed, with final inclusion of 60. Studies were distributed across airway (40%), neuromuscular (28%), central nervous system (10%), cardio-respiratory (2%), and multiple (20%) disease categories. Of the 18 airway studies reporting on NIV outcomes, 13 (72%) reported improvements in respiratory parameters. Of the 12 neuromuscular studies exclusively on spinal muscular atrophy type 1 (SMA1), six (50%) reported decreased hospitalizations and nine (75%) reported on mortality outcomes. Risk of bias was moderate to serious, and quality of the evidence was low to very low for all studies. Most studies had an observational design with no control group, limiting the potential for a meta-analysis.ConclusionThe outcomes reported in studies differed by the disease category being studied. Studies on airway conditions showed improvements in respiratory parameters for infants using NIV. Studies on neuromuscular disorder, which were almost exclusively on SMA1, reported decreased hospitalizations and prolonged survival. Overall, it appears that NIV is an effective long-term therapy for infants. However, the high risk of bias and low quality of the available evidence limited strong conclusions.

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“…One study of children with PRS found that those undergoing tracheostomy tended to have a lower birth weight and an underlying syndrome, and spent more time in the ICU and hospitalized than those undergoing other procedures [47]. Having a tracheostomy requires extensive training for parents; infants usually require constant monitoring, and there are risks of significant complications, including airway obstruction, that may result in death.…”

Section: Management Of Upper Airway Obstructionmentioning

confidence: 99%

Craniofacial disorders associated with airway obstruction in the neonate

Cielo

Montalva

Taylor

2016

Seminars in Fetal and Neonatal Medicine

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SUMMARY In infants with craniofacial disorders, upper airway obstruction is one of the primary causes for morbidity and mortality in the neonatal period. Infants with craniofacial disorders, including Pierre Robin sequence, are at high risk for obstructive sleep apnea syndrome. Because of the complexity of their care, these neonates are usually followed by a multidisciplinary team to ensure timely evaluation and optimal treatment. In addition to history and physical examination, clinical evaluation may include genetic testing, imaging, endoscopy, and polysomnography. There are various treatment options, both surgical and non-surgical, that may be used depending on clinical assessment, underlying condition, and severity of disease. Recent advances have led to better assessment and treatment of these patients, but many questions remain. This review outlines the available literature pertaining to the evaluation and management of upper airway obstruction in the neonate with craniofacial conditions, with a particular focus on Pierre Robin sequence.

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Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

Cited by 22 publications

References 30 publications

Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013

Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013

Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis

Craniofacial disorders associated with airway obstruction in the neonate

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