Robin Sequence: From Dilemmas to Developing an Adaptable Standardized Stepwise Approach

Aim

To review the literature to identify key issues causing variation in clinical practice, assess the knowledge gap, and develop a standardised pathway for managing upper airway obstruction (UAO) in infants with Robin sequence (RS).

Methods

The tripartite framework of evidence-based practice, which included a systematic review of the literature, extensive consultation with a multidisciplinary team of experts, and feedback from the patients was used.

Results

Of the 2672 articles from the initial search, 66 were studied in detail. We identified five pivotal issues prevalent while managing UAO in RS. These issues were addressed systematically to develop an adaptable stepwise standardised pathway. The main pillars of the pathway are (a) early objective assessment of the severity of UAO using polysomnography, (b) graded treatment approach based on centre-specific preferences, (c) early and regular multidisciplinary team discussions and (d) clearly defined criteria for treatment escalation or cessation, discharge and follow-up.

Conclusion

This unique pathway is based on available evidence, consensus of experts and parents' feedback. It provides a stepwise guide to the clinician for the management of UAO in infants with RS, adaptability for centre-specific treatment preferences and framework for future comparisons of different treatments.