Clinical Pathway for Evaluation/Treatment of the Neonate/Infant with Micrognathia/Retrognathia and Concern for Airway Obstruction

 
 
Team Assessment
  • History and Physical
    • Note positioning (e.g., supine, prone, side-lying) when assessing vital signs
  • Subspecialty Consults
  • Imaging recommended by Plastic Surgery
    • If extubated, obtain 2 View Skull X-ray
    • If intubated, obtain Facial 3D CT Scan
 
 
 
 
 
 
No Airway Support
Non-Invasive Airway Support
 
 
Successful Extubation
Airway Considerations
 
 
 
 
Trial Off Non-Invasive Airway Support
 
Successful
 
 
 
Unsuccessful
 
 
  • Sleep Study to assess for OSA
  • OSA severity should be considered in the context of other clinical factors to determine respiratory support and surgical candidacy
 
 
Review with Plastic Surgery, Pulmonary, and/or ENT
 
 
 
 
 
 
Non-Surgical Management
Tracheostomy Candidate
  • Lower severity apnea
  • Adequate PO feeding
Favorable anatomy based
on exam, imaging
  • Multi-level airway obstruction
  • Neurologic impairment
  • Severe genetic syndromes
 
 
 
 
 
 
Pulmonary assessment for initiation of respiratory support as indicated
Drug-Induced Sleep Endoscopy (DISE) and MDO as indicated
  • Discuss continued respiratory support (e.g., nasal cannula)
  • Discuss sleep study titration
    if on CPAP
 
 
Repeat Sleep Study
Tracheostomy as indicated
 
 
 
 
 
 
Posted: February 2017
Last Revised: November 2024