GP2b - Comorbidities and Feeding Challenges After Mandibular Distraction Osteogenesis in Robin Sequence Patients

Abstract:

Background: Mandibular distraction osteogenesis (MDO) is an effective technique for improving respiratory and feeding function in patients with Robin Sequence (RS).^1,2 While many patients with RS have comorbid conditions, there is limited data regarding their impact on feeding outcomes after MDO. We aim to examine the relationship between comorbidities and feeding outcomes in patients with RS who underwent MDO.

Methods: A retrospective review of patients with RS who underwent MDO at a tertiary children’s hospital between 2004 and 2022 was conducted. Patients with preoperative tracheostomy or less than one year of follow-up were excluded. Data on respiratory, cardiac, gastrointestinal and neuromuscular comorbidities were collected. Primary outcome measures included gastrostomy tube (G-tube) placement and time from surgery to full per-os (PO) intake. Statistical analyses were conducted using chi-squared tests and Mann-Whitney U tests.

Results:
A total of 73 patients met inclusion criteria. Patients had a median corrected gestational age at MDO of 4.3 weeks (IQR: 2.4-7.4 weeks) and were distracted to a median distance of 30.0 mm (IQR: 25-30 mm). Twenty-seven patients (37.0%) had respiratory comorbidities, including central sleep apnea (40.7%), laryngomalacia (22.2%), and subglottic stenosis (11.1%). Twenty-one patients (28.8%) had cardiac comorbidities, including atrial septal defect (42.9%), patent ductus arteriosus (23.8%), and ventricular septal defect (14.3%). Additionally, 28 patients (38.4%) had gastroesophageal reflux disease and 22 patients (30.1%) had hypotonia. Postoperative G-tube placement rates were 5.0% for patients with one comorbidity, 21.4% for those with two comorbidities, 33.3% for those with three comorbidities, and 58.3% for patients with three or more comorbidities (P = .011). The risk of postoperative G-tube placement was 10.5 times higher in patients with three comorbidities compared to those with no comorbidities (P = .001). Hypotonia was associated with the highest rate of G-tube placement (45.5%) and the lowest rate of full PO intake (68.2%). Only 73% of patients with one or more comorbidities reached full PO intake, while 100% of patients with no comorbidities achieved full PO intake (P = .03). The time required to achieve full PO intake did not significantly vary between those with and without comorbidities.

Conclusion: The prevalence of comorbid conditions in patients with RS was associated with higher rates of postoperative G-tube placement and a lower likelihood of achieving full PO intake. For patients with 3 or more comorbidities, considering G-tube placement at the time of MDO surgery may be beneficial due to the significantly higher rates of postoperative G-tube placement observed in this group. G-tube placement can provide essential nutritional support, which is critical for recovery and healing during the postoperative catabolic state.

References:
1.Breik O, Umapathysivam K, Tivey D, Anderson P. Feeding and reflux in children after mandibular distraction osteogenesis for micrognathia: A systematic review. International Journal of Pediatric Otorhinolaryngology. 2016;85:128-135. doi:10.1016/j.ijporl.2016.03.033
2. Nazarian Mobin SS, Francis CS, Karatsonyi AL, Hammoudeh JA, Urata MM. Mandibular Distraction Instead of Tracheostomy in Pierre Robin Sequence Patients: Is It Worth It? Plastic and Reconstructive Surgery. 2012;130(5):766e-767e. doi:10.1097/PRS.0b013e318267da28