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Feeding and Swallowing Outcomes in Pierre-Robin Sequence: a 10-Year Cohort Study
Nicolás M Kass, Angel Dixon, Alexander J. Comerci, Anne Glenney, Casey Zhang, Pooja Humar, Megan Pencek, Matthew Ford, Jesse A. Goldstein
UPMC
2024-01-15
Presenter: Nicolás Kass
Affidavit:
Vu Nguyen
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Although surgical intervention is performed in patients with Pierre-Robin Sequence (PRS) to maintain airway patency, feeding and swallowing dysfunction remain a significant contributor to patient morbidity. We conducted a retrospective cohort study of feeding/swallowing outcomes in PRS patients following surgical intervention or conservative management.
Methods: PRS patients who underwent mandibular distraction osteogenesis (MDO) or conservative management between 2010 and 2021 were included. Feeding outcomes were evaluated from clinical/radiographic evaluations, modified barium swallow studies (MDS) and polysomnography data.
Results: Ninety-three patients were included. Fifty-eight (62.4%) were male. Almost all required a prolonged stay in the NICU (79/93, 84.9%), for a mean of 38.8 (SD 15.7) days. The majority of surgical patients received an MDO (47/63, 74.6%) while a small number received a supraglottoplasty (11/63, 17.5%) or combined procedure (5/63, 0.1%). Surgery significantly improved the Apnea-Hypopnea Index (AHI) (median 17.3 vs 4.35, p<<0.001) and MBS t (Z= 2.479, p=.01). The majority of patients were able to feed exclusively by mouth (48/84, 57.1%), 23/84 (27.3%) were "safe for PO", but required gastrostomy tube, and 13/84 (15.5%) continued requiring gastrostomy tube due to inability to safely feed by mouth.
Conclusions: We found surgical intervention to be highly successful in improving both airway and feeding outcomes, although small cohort of patients remained unsafe for oral feeding and dependent on gastrostomy-tube feeds. Our results can be used to discuss expectations with patient families and inform clinical decision making.
