Intensive Care Unit Admission Following Cleft Palate Repair in Patients With Pierre Robin Sequence Corrected With Mandibular Distraction.

Background: Patients with Pierre Robin Sequence (PRS) treated with mandibular distraction (MD) frequently suffer from a cleft palate (CP). There are no standard practices surrounding the need for admission to a pediatric intensive care unit (PICU) following CP repair in these patients. This study will investigate the frequency of airway events following CP repair in this subset of patients.

Methods: A retrospective chart review of all patients with PRS treated with MD that also required CP repair surgery at the authors' institution from 2012 to 2022 was performed. Intraoperative and postoperative analgesic usage, preoperative and postoperative respiratory status, presence of a concomitant operation, comorbid anomalies, as well as age and weight at CP repair were recorded. Our primary outcomes included length of stay following CP repair, presence of airway events perioperatively/postoperatively, and admission status following CP repair.

Results: Twenty-nine patients underwent MD during this period, of which 13 patients also underwent repair of a CP. The average length of stay following CP repair was 2.3 days. Only 2 airway events were noted, and only 3 patients were admitted to the PICU following repair. Presence of comorbid musculoskeletal and neurologic abnormalities was associated with postoperative PICU admission.Remaining intubated following CP repair was associated with increased analgesic usage intraoperatively. A longer duration of intubation following MD was associated with PICU admission and remaining intubated following CP repair.

Conclusions: Overall, it appears that admission to the floor following CP repair in PRS patients with a history of MD is generally safe.