Predicting Surgical Intervention in Micrognathic Infants.

Objective: To determine which factors in the early neonatal period may predict subsequent need for surgical intervention in infants with micrognathia. Method: A retrospective case series of 123 infants from 2 tertiary pediatric referral centers over a 10-year period. Results: Forty-eight (39%) of micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of tracheostomy (n = 12), mandibular distraction osteogenesis (MDO) (n = 33), or prolonged intubation prior to withdrawal of care (n = 3). Factors associated with a need for definitive airway intervention included a history of intubation or tracheotomy in the first 24 hours of life (OR: 8.22; CI: 3.14-21.54), a history of intrauterine growth restriction (OR: 4.1; CI: 1.00-16.71), neurologic impairment (OR: 3.83; CI: 1.33-11.06), and prematurity (<37 weeks gestational age) (OR: 2.38; CI: 1.02-5.56). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR: 0.2; CI: 0.05-0.71). Conclusion: While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors, which may predict which neonates with micrognathia are at increased risk for requiring early surgical intervention for respiratory and feeding problems.