Management of neonatal upper airway obstruction: Decreased morbidity by utilizing a decision tree model with mandibular distraction osteogenesis

Abstract

Objective: Upper airway obstruction in a newborn with a craniofacial anomaly requires urgent management. While tracheostomy may be life saving in these circumstances, it may be associated with numerous morbidities. Distraction osteogenesis (DO) or lengthening of the mandible offers an alternative to tracheostomy with proper patient selection.

Study Design: A ten-year review of neonates with upper airway obstruction at two academic centers was performed (n=149). We compared conventionally treated neonates, receiving home monitoring or a tracheostomy on a case by case basis, to newborns managed by a new decision tree model (DTM), in which a specific pattern of diagnostic tests and specialist consultations were obtained to decide among home monitoring, tracheostomy, or distraction.

Results: Neonates managed with our DTM were significantly less likely to undergo a tracheostomy than those managed conventionally. In our DTM group, no deaths occurred and only one of 43 children who initially underwent DO required subsequent tracheostomy. In the conventionally managed children there were 3 deaths and significantly more hospital days, emergency department visits, respiratory infections, and gastrointestinal reflux. The DTM group had improved feeding, growth, and speech.

Conclusion: In treating newborns with micrognathia and upper airway obstruction, patient outcomes may be improved by utilizing a decision tree model with multidisciplinary specialists, timely studies, and an option for mandibular distraction osteogenesis.