Comparative effectiveness of pre-epiglottic baton plates and mandibular distraction in infants with Robin sequence.

Background: Mandibular distraction osteogenesis (MDO) and pre-epiglottic baton plates (PEBP) are both effective for early management of upper airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding and growth outcomes between these treatments.

Methods: This is a bicentric retrospective cohort study from 2015-2021 including infants with RS treated with MDO or PEBP before 6 months-of-age with pre- and post-treatment sleep studies and follow-up at least through age 1-year. The primary outcome was immediate post-intervention UAO, measured as obstructive apnea-hypopnea index (oAHI) or obstructive apnea index (oAI), as available. Latest follow-up sleep studies, feeding and growth characteristics were also assessed.

Results: 114 subjects were included: MDO, n=31 and PEBP, n=83. Pre-treatment UAO was similar between groups (p=0.61). PEBP was initiated at a younger age (median [IQR] 31 [14,53] vs. 41 [28,84] days-of-life, p<0.05). Significant reduction of oAHI/oAI was achieved in both groups, but greater with MDO (98%) compared to PEBP (94%, p<0.05). PEBP demonstrated better early feeding and growth outcomes compared to MDO, with fewer surgical feeding tubes (p<0.001) and more rapid early growth (p=0.038). When stratified by pre-intervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (p=0.11), while those with severe UAO had greater resolution with MDO (p<0.001).

Conclusion: Both treatments effectively relieve moderate UAO in infants with RS, but MDO is more effective for infants with severe respiratory compromise.