Detection of Chronic Hypoventilation Among Infants With Robin Sequence Using Capillary Blood Gas Sampling

Abstract

Objectives/Hypothesis: To describe the use of capillary blood gas (CBG) sampling to detect and quantify hypoventilation in infants with Robin sequence (RS).Methods: Case series with chart review at two institutions. Infants with RS presenting over a 10-year period were identified using departmental databases. CBG values obtained during infancy or until airway intervention (AI) were reviewed.Results: From 2008 to 2018, 111 infants with RS were identified as having had been assessed and managed from birth or transfer until discharge home and having CBG data available. In most cases, CBG sampling was obtained every other day until intervention or discharge. A total of 81 (73%) infants required AI: 72 (89%) underwent mandibular distraction osteogenesis, five (6%) underwent tracheotomy, and four (5%) were discharged home with a nasopharyngeal airway. The mean PCO 2 at day of life (DOL) 7-30 for the AI group was 52.7 mmHg (95% confidence interval: 51.7-53.7) and for the no AI group was 45.9 mmHg (44.8-47.0; P < .0001). The mean HCO 3 at DOL 7-30 for the AI group was 29.8 mEq/L (29.4-30.1) and for the no AI group was 27.0 mEq/L (26.5-27.4; P < .0001). Receiver operating characteristic curves were created for maximum PCO 2 and HCO 3 values and cutoffs were established by optimizing a balance of sensitivity and specificity. Infants requiring AI surpassed the PCO 2 and HCO 3 cutoff at a median of DOL 9.Conclusions: Among infants with RS and hypoventilation, objective measures of respiratory acidosis may be apparent by DOL 9.

The Safety and Efficacy of Mandibular Distraction Osteogenesis Among Infants Less Than 3 kg

“…At both institutions, patients in this study underwent continuous pulse oximetry and capillary blood gas (CBG) drawn in the first 24 hours of evaluation and typically 2 days following the initial CGB. 19 Conservative management with positioning was attempted first by placing the patient in a prone position if they had desaturations while supine. Intervention with a nasal trumpet also was attempted.…”

Defining Age-related OSA Features in Robin Sequence Using Polysomnographic-based Analyses of Respiratory Arousal Responses and Gas-exchange Parameters

“…Fahradyan et al (2019) reported the use of CBG CO 2 in 73 patients with RS and stated that ROC curves with cutoff value of pCO 2 level of 49.5 is the best among other variables in terms of specificity and sensitivity combination as an “indication” for surgical intervention. Kwan et al (2021) also noted that a PCO 2 cutoff of 55 mmHg (sensitivity = 55.7%; specificity = 91.3%; area under the curve = 0.78) and a HCO 3 cutoff of 30 mEq/L (sensitivity = 56.2%; specificity = 95.0%; area under the curve = 0.80) were most predictive of patients who “required” a surgical airway. Neither of these studies documented how the authors determined surgical airway indications, raising the question of circular reasoning, ie, the factors found by the authors to “predict” the need for surgical airway were, in fact, the very reasons used to determine the “need” for surgery.…”