The Effect of Timing of Mandibular Distraction Osteogenesis on Weight Velocity in Infants Affected by Severe Robin Sequence.

Zhe Mao,Mayank Shrivastava,Yingqiu Cui,Ricardo Battaglino,Liang Ye,Gabriel Tian,Faezeh Sahebdel,Jiawei Zhou

doi:10.3390/children9030319

Abstract

Background: Impaired weight gain is prevalent in Robin Sequence (RS) newborns. Although mandibular distraction osteogenesis (MDO) has been proven to improve oral feeding, its impact on postoperative weight gain remains unclear. The purpose of this study is to explore whether MDO can help RS babies reach a normal weight, as well as the effect of MDO timing on weight velocity. Methods: One hundred infants with severe RS and one hundred with normal controls met the inclusion criteria for the study. Included patients underwent MDO. Weights at different timing points were recorded and analyzed and compared to normal controls. Results: After the distractor removal weights of patients undergoing MDO at <1 month and 1–2 months were close to the normal control (6.81 ± 0.93 kg versus 7.18 ± 0.61 kg, p = 0.012, and 6.82 ± 0.98 kg versus 7.37 ± 0.75 kg, p = 0.033, respectively), the weights of patients undergoing MDO at 2–3 months and 3–4 months still lagged behind (7.56 ± 1.29 kg versus 8.20 ± 0.61 kg, p = 0.000206 and 7.36 ± 1.05 kg versus 8.25 ± 0.77 kg, p = 0.004, respectively). The weights of all RS infants undergoing MDO showed no significant difference compared to the controls when they aged to 1 year (9.34 ± 0.99 kg versus 9.55 ± 0.45 kg, p = 0.254 for MDO at <1 month; 9.12 ± 0.91 kg versus 9.33 ± 0.46 kg, p = 0.100 for MDO at 1 to 2 months; 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 2 to 3 months; and 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 3 to 4 months). Conclusion: The MDO procedure helped patients with severe RS to reach a normal weight; and MDO intervention was recommended at an early stage for early weight gain.

Highlights

Robin Sequence (RS) is described as a craniofacial abnormality that demonstrates clinical features of micrognathia, glossoptosis, and upper airway obstruction
In infants with RS, micrognathia is a striking feature which along with retrogenia and glossoptosis leads to airway obstruction followed by respiratory distress and feeding impairment
There were more cases affected by isolated RS compared to those affected by syndromic RS

Summary

Introduction

Robin Sequence (RS) is described as a craniofacial abnormality that demonstrates clinical features of micrognathia, glossoptosis, and upper airway obstruction. It is observed that in RS, mandibular position is altered causing a physical obstruction of nasal and oral passages by not allowing the tongue base to descend from nasopharynx and by inhibiting the fusion of palate. These alterations limit the formation of negative intraoral pressure as well as negative intrathoracic pressure which successively increases respiratory effort and energy expenditure in infants, causing infants to fail to gain weight in the early post-natal period [5,6]. Conclusion: The MDO procedure helped patients with severe RS to reach a normal weight; and MDO intervention was recommended at an early stage for early weight gain

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Results