Cole et al reported a clinical classification for neonates with Pierre Robin sequence. The authors are from the West Midlands Regional Cleft Lip and Palate Service at Birmingham Children's Hospital in the UK.
Patient selection: Pierre Robin sequence (micrognathia, glossoptosis, cleft palate)
Parameters:
(1) respiratory distress when nursing
(2) glossoptosis
(3) feeding
Respiratory Distress
Glossoptosis
Feeding
Grade
none when nursed supine
inconsistent
satisfactory with adequate growth
1
intermittent and mild when nursed supine; none if nursed on side
consistent
some respiratory distress; failure to thrive
2
moderate to severe respiratory distress when nursed supine; respiratory distress when nursed on side
consistent
unable to feed orally
3
Nursing prone is discouraged for a number of reasons: obscures respiratory difficulties; problems with parental interaction, inability to detect intercostal recession.
A neonate who is Grade 3 usually requires:
(1) relief of airway obstruction with guaranteed airway
(2) monitoring of oxygen saturation
(3) monitoring of weight gain
(4) feeding with nasogastric tube
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