![]() Sixteen lead polysomnography, in particular offers a thorough evaluation of neonatal sleep and respiratory function. In these settings, polysomnography (PSG) has been utilized to establish and characterize the presence of apneic events and to quantify the frequency and degree of airway obstruction. Mild to moderate cases of Pierre Robin sequence, however, where profound desaturation and cyanosis are often absent, present diagnostic challenges to clinicians. Such subclinical aspiration can be a substantial source of morbidity. The increased negative intrathoracic pressure then overcomes lower esophageal sphincter tone, and the gastric contents are “sucked” into the esophagus and the bronchial tree. As the tongue falls back, infants may increase inspiratory pressures in order to overcome the obstruction. Finally, gastroesophageal reflux (GER), although common in many infants, is especially challenging in those with Robin sequence with a reported incidence as high as 85 %. Second, feeding in infancy poses substantial metabolic demands, and patients with subnormal oxygenation may present with “exercise-induced” anorexia. Indeed, primary oropharyngeal dysmotility has been noted in some patients. First, the small mandible and tongue malposition as well as the presence of a palatal cleft pose significant physical restrictions on infant suckling. There are several reasons for feeding difficulties in PRS. In the first weeks of life, patients with moderate obstruction may present during an initial well child visit with inadequate weight gain, cachexia, or even failure to thrive sometimes without a history of apneic events.
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