Multicenter study on the effectiveness of the pre-epiglottic baton plate for airway obstruction and feeding problems in Robin sequence

Christian F Poets, Christoph Maas, Wolfgang Buchenau, Joerg Arand, Anne Vierzig, Bert Braumann, Silvia Müller-Hagedorn, Christian F Poets, Christoph Maas, Wolfgang Buchenau, Joerg Arand, Anne Vierzig, Bert Braumann, Silvia Müller-Hagedorn

Abstract

Background: Treatment of Robin sequence is often either invasive or of unproven effectiveness. The pre-epiglottic baton plate (PEBP) is a well-studied alternative, yet is not widely applied internationally. We report on a prospective 3-center cohort study investigating this treatment. Based on an agreed protocol, parents of infants with Robin sequence referred to participating centers were offered enrollment, which involved taking a maxillary cast followed by endoscopy to fit the plate and sleep studies to monitor its effectiveness. Recordings were centrally analyzed by sleep specialists blinded to timing and center. Primary outcome was the mixed-obstructive apnea index, defined as the number of such apneas/h of sleep; secondary outcomes included the desaturation index to <80% pulse oximeter saturation and weight gain.

Results: Of 75 infants referred, 49 could be included; 1 center failed to perform appropriate sleep studies. Within a mean hospitalization of 3 weeks, the mixed-obstructive apnea index decreased (median; interquartile range) from 15.9 (6.3-31.5) to 2.3 (1.2-5.4); it decreased further to 0.7 (0.1-2.4) in the 32 infants who had a successful 3-month follow-up sleep study performed. The desaturation index normalized (from 0.38 (0-2.7) to 0.0 (0-0.1)). Mean standard deviation score for weight remained unchanged between admission and follow-up, while the proportion of tube-fed infants decreased from 74 to 14%.

Conclusions: This prospective multi-center cohort study confirms retrospective audits on the effectiveness of PEBP treatment in improving upper airway obstruction and feeding problems, the main clinical problems of infants with Robin sequence. International collaboration is required to compare this with other treatment approaches.

Trial registration: Number NCT02266043 , Registered 30/09/2014; registered partially retrospectively.

Keywords: Failure to thrive; Pierre-Robin sequence; Upper airway obstruction.

Figures

Fig. 1
Fig. 1
Patient Flow through this study. RS-Infants, infants with (Pierre-) Robin sequence; PEBP, pre-epiglottic baton plate. # In 7 infants with mild degree of upper airway obstruction a palatal plate without a spur was used, in 2 infants a CPAP-device or naso-pharyngeal tube was applied, 1 infant had early tracheostomy. * 1 study center (Würzburg) did not succeed in setting up and performing sleep studies, therefore the 4 patients referred to this center could not be included in the study
Fig. 2
Fig. 2
Boxplots showing results for the Mixed-Obstructive Apnea Index as the primary outcome of this study, studied upon admission, prior to hospital discharge, and at a 3-month follow-up visit

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