Do Infants With Robin Sequence Have Improved Feeding and Weight Gain After Mandibular Distraction?

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: 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.