Abstract：
BACKGROUND: Pierre Robin sequence (PRS), characterized by micrognathia, glossoptosis, cleft palate, and obstructed airways, is one of the craniofacial conditions challenging various approaches to managing compromised airways, ranging from conservative measures to invasive airway surgery. This study was conducted to identify predictive risk factors for tracheostomy in the PRS.
METHODS: A retrospective chart review was conducted at a tertiary referral hospital in Thailand. Children diagnosed with PRS from January 2010 to December 2021 were enrolled. Univariate and multivariate analysis methods were used to identify the risk factors.
RESULTS: Sixty-five patients with PRS were identified in electronic medical records, but 6 were excluded. Thirteen of the remaining 59 patients underwent tracheostomy. There were no significant differences in sex, preterm gestational age, cleft palate, associated syndromes, chromosome abnormalities, or cardiac or neurological involvement between patients who received tracheostomy and those who did not. However, patients with oropharyngeal dysfunction who received tracheostomy tended to use a nasogastric tube or percutaneous gastrostomy 92.3% of the time ( P = 0.043). In addition, patients with abnormal airways from endoscopy were more likely to undergo tracheostomy (odds ratio, 2.17; 95% confidence interval [CI], 1.20-3.90). Interestingly, patients with a sum of Apgar scores at 1 and 5 minutes <15 were more likely to undergo tracheostomy (adjusted odds ratio, 9.91; 95% CI, 1.32-74.52). Furthermore, patients with at least 3 identified comorbidities were more likely to undergo tracheostomy (adjusted odds ratio, 11.34; 95% CI, 1.16-111.15).
CONCLUSIONS: The need for tracheostomy depends on comorbidities, Apgar scores, and abnormal airway anatomy. Feeding methods can become more complex with tracheostomy. Prognostic risk factors can help guide treatment and counseling for health care workers and caregivers.
METHODS: A retrospective chart review was conducted at a tertiary referral hospital in Thailand. Children diagnosed with PRS from January 2010 to December 2021 were enrolled. Univariate and multivariate analysis methods were used to identify the risk factors.
RESULTS: Sixty-five patients with PRS were identified in electronic medical records, but 6 were excluded. Thirteen of the remaining 59 patients underwent tracheostomy. There were no significant differences in sex, preterm gestational age, cleft palate, associated syndromes, chromosome abnormalities, or cardiac or neurological involvement between patients who received tracheostomy and those who did not. However, patients with oropharyngeal dysfunction who received tracheostomy tended to use a nasogastric tube or percutaneous gastrostomy 92.3% of the time ( P = 0.043). In addition, patients with abnormal airways from endoscopy were more likely to undergo tracheostomy (odds ratio, 2.17; 95% confidence interval [CI], 1.20-3.90). Interestingly, patients with a sum of Apgar scores at 1 and 5 minutes <15 were more likely to undergo tracheostomy (adjusted odds ratio, 9.91; 95% CI, 1.32-74.52). Furthermore, patients with at least 3 identified comorbidities were more likely to undergo tracheostomy (adjusted odds ratio, 11.34; 95% CI, 1.16-111.15).
CONCLUSIONS: The need for tracheostomy depends on comorbidities, Apgar scores, and abnormal airway anatomy. Feeding methods can become more complex with tracheostomy. Prognostic risk factors can help guide treatment and counseling for health care workers and caregivers.
摘要：
背景：皮埃尔·罗宾序列（PRS），以微下颌畸形为特征，舌下垂，腭裂,和阻塞的气道，是挑战各种管理受损气道的方法的颅面疾病之一，从保守措施到侵入性气道手术。本研究旨在确定PRS中气管造口术的预测危险因素。
方法：在泰国一家三级转诊医院进行了回顾性图表回顾。纳入2010年1月至2021年12月诊断为PRS的儿童。采用单因素和多因素分析方法识别危险因素。
结果：在电子病历中发现了65例PRS患者，但6个被排除在外。其余59例患者中有13例接受了气管造口术。性别没有显著差异,早产胎龄,腭裂,相关综合征，染色体异常,或接受气管造口术的患者与未接受气管造口术的患者之间的心脏或神经系统受累。然而,接受气管造口术的口咽功能障碍患者在92.3%的时间内倾向于使用鼻胃管或经皮胃造口术(P=0.043).此外,内窥镜检查气道异常的患者更有可能接受气管造口术(比值比，2.17；95%置信区间[CI]，1.20-3.90)。有趣的是,Apgar评分总和在1和5分钟<15的患者更有可能接受气管造口术(调整后的比值比，9.91；95%CI，1.32-74.52）。此外，至少有3种确定的合并症的患者更有可能接受气管造口术(调整后的比值比，11.34；95%CI，1.16-111.15）。
结论：气管切开术的需要取决于合并症，阿普加得分,和异常的气道解剖结构。气管造口术可以使喂养方法变得更加复杂。预后风险因素可以帮助指导医护人员和护理人员的治疗和咨询。
方法：在泰国一家三级转诊医院进行了回顾性图表回顾。纳入2010年1月至2021年12月诊断为PRS的儿童。采用单因素和多因素分析方法识别危险因素。
结果：在电子病历中发现了65例PRS患者，但6个被排除在外。其余59例患者中有13例接受了气管造口术。性别没有显著差异,早产胎龄,腭裂,相关综合征，染色体异常,或接受气管造口术的患者与未接受气管造口术的患者之间的心脏或神经系统受累。然而,接受气管造口术的口咽功能障碍患者在92.3%的时间内倾向于使用鼻胃管或经皮胃造口术(P=0.043).此外,内窥镜检查气道异常的患者更有可能接受气管造口术(比值比，2.17；95%置信区间[CI]，1.20-3.90)。有趣的是,Apgar评分总和在1和5分钟<15的患者更有可能接受气管造口术(调整后的比值比，9.91；95%CI，1.32-74.52）。此外，至少有3种确定的合并症的患者更有可能接受气管造口术(调整后的比值比，11.34；95%CI，1.16-111.15）。
结论：气管切开术的需要取决于合并症，阿普加得分,和异常的气道解剖结构。气管造口术可以使喂养方法变得更加复杂。预后风险因素可以帮助指导医护人员和护理人员的治疗和咨询。
