Buchenau Wolfgang, Wenzel Sarah, Bacher Margit, Müller-Hagedorn Silvia, Arand Joerg, Poets Christian F
Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
BIP-Orthodontic Practice, Tübingen, Germany.
Arch Dis Child Fetal Neonatal Ed. 2017 Mar;102(2):F142-F146. doi: 10.1136/archdischild-2016-311407. Epub 2016 Jul 19.
Robin sequence (RS), characterised by micrognathia/retrognathia and glossoptosis with or without cleft palate, presents with intermittent upper airway obstruction and feeding difficulties. Active intervention is required to reduce the risk of brain damage or sudden death. Most treatment options are poorly studied and/or invasive. Our group developed a functional approach including early feeding training and the pre-epiglottic baton plate (PEBP), an orthodontic appliance with a velar extension shifting the base of the tongue forward.
We evaluated the effect of this approach on sleep study results and early weight gain by searching our electronic patient database for infants with isolated RS, born at or referred to our department between 1 January 2003 and 31 December 2012 and treated with the PEBP.
Of 122 patients identified, 360 overnight sleep study results, obtained at admission, prior to hospital discharge and 3 months postdischarge, were available (117 infants had complete data). These showed a decrease in the mixed-obstructive apnoea index from (median; IQR) 8.8 (2.1-19.7) to 1.8 (0.6-5.4); p<0.001 and 0.2 (0-1.3); p<0.001, respectively. Z-scores for weight improved from -0.7 (-1.39 to -0.24) upon admission to -0.5 (-0.90 to +0.02) at follow-up (p=0.02), accompanied by a decrease in the proportion of infants requiring nasogastric tube feeding from 66% to 8%. No infant required craniofacial surgery or tracheostomy.
These longitudinal cohort data suggest that this functional approach may be an option to treat both, upper airway obstruction and feeding problems, in infants with isolated RS.
罗宾序列征（RS）的特征为小下颌/后缩下颌以及舌后坠，伴或不伴有腭裂，表现为间歇性上呼吸道梗阻和喂养困难。需要积极干预以降低脑损伤或猝死风险。大多数治疗方案研究不足和/或具有侵入性。我们团队开发了一种功能性方法，包括早期喂养训练和会厌前棒板（PEBP），这是一种带有腭部延伸装置的正畸矫治器，可将舌根向前移位。
我们通过检索电子患者数据库，评估该方法对睡眠研究结果和早期体重增加的影响，数据库纳入了2003年1月1日至2012年12月31日期间在我院出生或转诊至我院、患有孤立性RS并接受PEBP治疗的婴儿。
在122例确诊患者中，可获取入院时、出院前及出院后3个月的360份夜间睡眠研究结果（117例婴儿有完整数据）。结果显示，混合性阻塞性呼吸暂停指数从中位数（四分位间距）8.8（2.1 - 19.7）降至1.8（0.6 - 5.4）；p<0.001，以及降至0.2（0 - 1.3）；p<0.001。体重Z评分从入院时的 - 0.7（ - 1.39至 - 0.24）改善至随访时的 - 0.5（ - 0.90至 + 0.02）（p = 0.02），同时需要鼻胃管喂养的婴儿比例从66%降至8%。没有婴儿需要进行颅面手术或气管切开术。
这些纵向队列数据表明，这种功能性方法可能是治疗孤立性RS婴儿上呼吸道梗阻和喂养问题的一种选择。
