Using continuous nasal airway pressure in infants with craniofacial malformations

  • Alessandro Amaddeo
    Correspondence
    Corresponding author. Pediatric Emergency Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137, Trieste, Italy.
    Affiliations
    Emergency Department, IRCCS Burlo Garofolo, Trieste, Italy
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  • Lucie Griffon
    Affiliations
    Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, F-75015, Paris, France

    Université de Paris, VIFASOM, F-75004, Paris, France
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  • Brigitte Fauroux
    Affiliations
    Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, F-75015, Paris, France

    Université de Paris, VIFASOM, F-75004, Paris, France
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Published:September 17, 2021DOI:https://doi.org/10.1016/j.siny.2021.101284

      Highlights

      • Continuous positive airway pressure (CPAP) is effective for treating obstructive sleep apnea in infants with craniofacial malformations.
      • A skilled paediatric multidisciplinary team with a CPAP/NIV unit is necessary to maximize treatment efficacy.
      • Currently no validated criteria exist on when to start and how to monitor CPAP in infants with craniofacial malformations.
      • Further studies are needed to identify validated criteria to start CPAP in infants with craniofacial malformation.

      Abstract

      Obstructive sleep apnea (OSA) is common in infants and children with craniofacial malformations. Continuous positive airway pressure (CPAP) represents an effective noninvasive treatment for severe upper airway obstruction in these children, reducing the need of surgery or a tracheostomy. The decision to start CPAP should be discussed by a multidisciplinary team in order to decide the optimal individualized treatment strategy. CPAP initiation depends on patients’ clinical characteristics and local practices, with an increase tendency towards an outpatient program. Follow-up and monitoring strategy varies among centers but benefits from the analysis of built-in software data in order to assess objective adherence and breathing parameters, reducing the need of in-hospital sleep studies. The possibility to wean CPAP should be periodically checked after surgical treatment or when spontaneous resolution is suspected. Finally, these infants with craniofacial malformations should have a long term follow up because of the risk of OSA recurrence over time.

      Keywords

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