Abstract
PURPOSE: Management of neonatal upper airway obstruction (UAO) in patients with Robin Sequence (RS) may impact the need for intensive care unit (ICU) care following primary palatoplasty (PP) later in life. The current study investigated the necessity for ICU admission after PP in patients with RS, based upon prior upper airway management. METHODS: We conducted a review of patients with RS who underwent PP between 2006-2020. Patient demographics, perioperative characteristics, ICU admission, and postoperative airway and non-airway complications were compared, based on prior airway management, as determined by multidisciplinary team evaluation and consensus. RESULTS: Fifty-eight patients were included. Median [IQR] age at PP was 12.9 [10.8,15.6] months. Three groups were compared: Conservative (n=30), tongue-lip adhesion (TLA) (n=14) and mandibular distraction osteogenesis (MDO) (n=14). While ICU admission (conservative, 33.3%; TLA, 78.6%; MDO, 78.6%; p=0.002) and overall airway-related complications were significantly higher in patients with prior TLA and MDO (conservative, 26.7%; TLA, 64.3%; MDO, 57.1%; p=0.034), rates of major post-PP airway events (prolonged intubation >4h, unexpected ventilatory support via pre-existing tracheostomy, or reintubation) that would have required ICU care were low and insignificant between groups (0-14.3%; p>0.05); post-hoc analysis documented significant differences only in overall airway events between TLA vs. conservative airway groups (64.3% vs. 26.7%; p=0.02). CONCLUSION: ICU care after PP in patients with RS may not be necessary for infants who had appropriate management of neonatal UAO, potentially preserving resources for patients with greater need. Special attention may be prudent for post-PP patients who underwent neonatal TLA.
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