Hamilton Stefan, Dzioba Agnieszka, Husein Murad
Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada.
Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada.
Int J Pediatr Otorhinolaryngol. 2020 Feb;129:109769. doi: 10.1016/j.ijporl.2019.109769. Epub 2019 Nov 7.
Robin sequence (RS) is a congenital set of abnormalities of the head and neck, consisting of a hypoplastic mandible (micrognathia), a tongue that is displaced posteriorly (glossoptosis), and obstruction of the airway. A clear set of diagnostic criteria for this complex condition has recently been established, but there is still no consensus in the literature with respect to managing the associated airway, feeding, and hearing difficulties. The objectives of the study are: 1) to describe the management of airway and feeding issues in children with RS; and 2) to evaluate the impact of airway and feeding strategies on important clinical outcomes.
A retrospective chart review was conducted of all pediatric patients diagnosed with RS at London Health Sciences Centre from January 1995 until September 2017. The frequencies of all airway and feeding interventions were collected. Data were collected on several clinical outcomes including initial admission length, enteral feeding duration, tympanostomy tube insertion frequency, and hearing thresholds. Statistical analyses to evaluate the impact of airway and feeding strategies on clinical outcomes were carried out using independent samples t-tests and Chi-square tests, where appropriate.
Twenty-four patients were identified. Five patients (20.8%) required airway surgery and 18 patients (75.0%) required enteral feeding. Airway surgery was significantly associated with a longer ICU admission (15.8 vs. 4.3 days, p < 0.05), a longer overall hospital admission (73.0 vs. 25.2 days, p < 0.05), a delay in introducing oral feeds (222.8 vs. 11.5 days, p < 0.05), and a higher frequency of tympanostomy tube insertions (80% vs. 23.5% requiring ≥2 insertions, p < 0.05). Enteral feeding was significantly associated with a longer ICU admission (8.8 vs. 0 days, p < 0.05) and a longer overall hospital admission (43.9 vs. 5.6 days, p < 0.05).
This study demonstrates the substantial impact that airway and feeding difficulties have on RS patient morbidity, particularly with respect to length of hospital and ICU admission. This information has prognostic value and may be helpful in generating a management algorithm for this complex patient population.
罗宾序列征（RS）是一组先天性头颈部异常，包括下颌骨发育不全（小颌畸形）、舌头后移（舌后坠）和气道阻塞。最近已为这种复杂病症制定了一套明确的诊断标准，但在文献中对于如何处理相关的气道、喂养和听力问题仍未达成共识。本研究的目的是：1）描述RS患儿气道和喂养问题的处理方法；2）评估气道和喂养策略对重要临床结局的影响。
对1995年1月至2017年9月在伦敦健康科学中心诊断为RS的所有儿科患者进行回顾性病历审查。收集所有气道和喂养干预措施的频率。收集了包括首次住院时间、肠内喂养持续时间、鼓膜置管频率和听力阈值在内的多项临床结局数据。在适当情况下，使用独立样本t检验和卡方检验进行统计分析，以评估气道和喂养策略对临床结局的影响。
共确定了24例患者。5例患者（20.8%）需要进行气道手术，18例患者（75.0%）需要进行肠内喂养。气道手术与更长的重症监护病房住院时间（15.8天对4.3天，p<0.05）、更长的总体住院时间（73.0天对25.2天，p<0.05）、口服喂养延迟（222.8天对11.5天，p<0.05）以及更高的鼓膜置管频率（80%对23.5%需要≥2次置管，p<0.05）显著相关。肠内喂养与更长的重症监护病房住院时间（8.8天对0天，p<0.05）和更长的总体住院时间（43.9天对5.6天，p<0.05）显著相关。
本研究表明气道和喂养困难对RS患者的发病率有重大影响，尤其是在住院时间和重症监护病房住院时间方面。这些信息具有预后价值，可能有助于为这一复杂患者群体制定管理算法。
