DMD Candidate, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
Clinical Research Specialist, Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA.
J Oral Maxillofac Surg. 2021 Jun;79(6):1331-1338. doi: 10.1016/j.joms.2021.01.029. Epub 2021 Jan 28.
Infants with Robin sequence (RS) typically have impaired weight gain, presumed to result primarily from upper airway obstruction. Operations that improve airway obstruction are therefore theorized to facilitate feeding and weight gain, but the relationship between airway intervention and feeding improvement remains unclear. The aim of this study was to evaluate weight gain over the first 3 years of life in patients with RS.
This is a retrospective cohort study of patients with RS treated at Boston Children's Hospital from 1995 to 2016. The primary predictor variable was type of intervention (no operation, tongue-lip adhesion, mandibular distraction osteogenesis [MDO]). The primary outcome measure was weight-for-age Z-score. A control group of patients with isolated cleft palate without RS was also included. Individuals with tracheostomy or insufficient growth data were excluded. Descriptive statistics were calculated, and statistical significance was set at P < .05.
A total of 222 subjects were included: no operation, n = 61 (27.5%); tongue-lip adhesion, n = 78 (35.1%); MDO, n = 22 (9.9%); and control, n = 61 (27.5%). Mean age at tongue-lip adhesion was 37 ± 99 days compared with 247 ± 312 days for MDO (P < .05). At 6 months of age, the MDO group had the lowest mean weight (Z = -2.34 ± 1.88, P < .05) and both surgical groups were underweight compared with controls (P < .05). By 24 months of age, there were no weight differences between any study group. Individuals that had MDO at <3 months of age had significantly faster weight gain than those that had later operations (P < .05).
Patients with RS who had an airway operation in the first year of life demonstrated poorer early weight gain but caught up to controls by 2 years of age. Patients that had MDO before 3 months of age had faster weight gain than those that had later operations. Neither age at operation nor type of intervention affected growth outcomes by 3 years of age, which were comparable with controls.
患有 Robin 序列（RS）的婴儿通常体重增长受损，据推测这主要是由于上呼吸道阻塞所致。因此，改善气道阻塞的手术被认为可以促进喂养和体重增加，但气道干预与喂养改善之间的关系仍不清楚。本研究的目的是评估 RS 患者生命的前 3 年的体重增加情况。
这是一项回顾性队列研究，纳入了 1995 年至 2016 年在波士顿儿童医院接受治疗的 RS 患者。主要预测变量是干预类型（无手术、舌唇粘连、下颌骨牵引成骨术[MDO]）。主要观察指标是体重与年龄的 Z 评分。还纳入了一组无 RS 的单纯腭裂患者作为对照组。排除了气管造口术或生长数据不足的个体。计算了描述性统计数据，统计学意义设定为 P<.05。
共纳入 222 例患者：无手术组，n=61（27.5%）；舌唇粘连组，n=78（35.1%）；MDO 组，n=22（9.9%）；对照组，n=61（27.5%）。舌唇粘连的平均年龄为 37±99 天，而 MDO 为 247±312 天（P<.05）。6 个月时，MDO 组的平均体重最低（Z=-2.34±1.88，P<.05），且两组手术组均比对照组体重偏轻（P<.05）。24 个月时，各研究组间体重无差异。3 个月内接受 MDO 的患者体重增加速度明显快于较晚手术者（P<.05）。
在生命的第一年接受气道手术的 RS 患者表现出早期体重增加较差，但到 2 岁时赶上了对照组。3 个月内接受 MDO 的患者体重增加速度快于较晚手术者。手术年龄和干预类型均不影响 3 岁时的生长结果，与对照组相当。
