Nicholas S. Mader

Regional variations in the presentation and surgical management of Pierre Robin sequence.

To estimate the current birth prevalence of isolated and syndromic Pierre Robin sequence (iPRS and sPRS), including demographic variations. To assess for regional variations in surgical airway interventions for PRS, and to determine the mean length of stay (LOS), cost of admission, complication rate, and rate of associated procedures related to tongue‐lip adhesion (TLA), neonatal mandibular distraction osteogenesis (MDO), and tracheotomy.

Predicting surgical intervention for airway obstruction in micrognathic infants.

Objective To determine which factors present in the neonatal period may predict subsequent need for surgical intervention in infants with micrognathia. Study Design Case series with chart review. Setting Two, urban, tertiary pediatric hospitals. Subjects and Methods The otolaryngology databases from 2 institutions were queried for the diagnosis of micrognathia over a 10-year period, and 123 infants were identified (101 with Pierre Robin sequence and 21 with micrognathia without cleft palate). The presence or absence of surgical airway intervention during the first year of life was noted, as were associated diagnoses. Univariate and multivariate analyses were performed to identify risk factors for requiring a definitive airway intervention. Results Forty-eight (39%) micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of either tracheostomy (12 patients), mandibular distraction osteogenesis (MDO; 33 patients) or prolonged intubation prior to death (3 patients). Factors associated with a need for intervention included a history of intubation or tracheotomy in the first 24 hours of life (odds ratio [OR], 8.22; confidence interval [CI], 3.14-21.53), a history of intrauterine growth restriction (OR, 4.10; CI, 1.00-16.70), prematurity (<37 weeks of gestational age; OR, 2.38; CI, 1.02-5.56), and neurologic impairment (OR, 3.83; CI, 1.33-11.07). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR, 0.20; CI, 0.05-0.71). Conclusions While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors that may predict which neonates with micrognathia are at increased risk for meriting early surgical intervention for respiratory and feeding problems.

Chapter 9 - The GED☆

The General Educational Development (GED) credential is issued on the basis of an eight-hour subject-based test. The test claims to establish equivalence between dropouts and traditional high school graduates, opening the door to college and positions in the labor market. In 2008 alone, almost 500,000 dropouts passed the test, amounting to 12% of all high school credentials issued in that year. This chapter reviews the academic literature on the GED, which finds minimal value of the certificate in terms of labor market outcomes and that only a few individuals successfully use it as a path to obtain post-secondary credentials. Although the GED establishes cognitive equivalence on one measure of scholastic aptitude, recipients still face limited opportunity due to deficits in noncognitive skills such as persistence, motivation, and reliability. The literature finds that the GED testing program distorts social statistics on high school completion rates, minority graduation gaps, and sources of wage growth. Recent work demonstrates that, through its availability and low cost, the GED also induces some students to drop out of school. The GED program is unique to the United States and Canada, but provides policy insight relevant to any nations educational context.

Determining risk factors for early airway intervention in newborns with micrognathia.

INTRODUCTION The ex utero intrapartum treatment (EXIT) procedure is used to establish and manage a fetal airway at delivery while maintaining placental support. Time, proficiency, and familiarity with the EXIT procedure have led to the expansion of its applications. Based on a series of three patients, Morris et al. have suggested that micrognathic infants with a jaw index <5 percentile and evidence of aerodigestive tract obstruction are indications for performing an EXIT procedure. In an effort to further our knowledge regarding prenatal counseling for optimal and appropriate airway management of micrognathic fetuses, this study examines the rate of airway intervention within the first 24 hours of life in 123 newborns with micrognathia, and identifies prenatal characteristics that represent risk factors for intervention.

National Trends in Tongue Reduction Surgery for Macroglossia in Children

Objectives: (1) Examine the frequency of partial glossectomy performed for the indication of macroglossia in the United States, assessing for any differences in rates of intervention across various demographics. (2) Identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay (LOS) and cost of admission following tongue reduction surgery. Methods: Retrospective cross-sectional study using the 2006 and 2009 KidsTM Inpatient Databases (KID). During the 2-year study period, partial glossectomy was performed in 80 children under 5 years with macroglossia. Results: A disproportionately higher rate of intervention was seen in whites (P = .001) and patients in the highest socioeconomic quartile (P = .007). Conversely, a lower rate of intervention was observed in black children (P = .011). The average age at the time of partial glossectomy was 23 months (mode, 12 months). Patients were classified as isolated (n = 16, 20%) or syndromic macroglossia (n = 64, 80%) based on associated diagnoses. The average length of stay after partial glossectomy for macroglossia ranged from 5 to 11 days. Differences in LOS (mean, 9.5 days) and cost (mean,

Neonatal Macroglossia: Demographics, Cost of Care, and Associated Comorbidities

9.8k) between isolated and syndromic macroglossia groups were not significant. Conclusions: Partial glossectomy for macroglossia is typically performed prior to age 2 years in the United States. Syndromic comorbidities do not seem to contribute to increased LOS or cost of admission. White children and affluent children appear to be undergoing partial glossectomy at a higher rate than their peers.

Predicting Surgical Intervention in Micrognathic Infants

Objectives: (1) Examine the birth prevalence of macroglossia, assessing for differences across sex, race, socioeconomic status, and geographic location. (2) Identify comorbidities associated with isolated and syndromic forms of macroglossia and determine how such factors may influence length of stay (LOS) and cost of admission. Methods: Retrospective cross-sectional study using the 2006 and 2009 Kids’ Inpatient Databases (KID). Results: The national birth prevalence of macroglossia was 3.4 out of 10,000 births (n = 556) with a higher rate in females (3.9/10,000, P = .001) and blacks (4.5/10,000, P = .01). Patients were classified as isolated (n = 423, 76%) or syndromic (n = 133, 24%) based on associated diagnoses. Syndromic cases were more prevalent in the West (P = .01). LOS and cost were increased in the syndromic group (26.2 days vs 4.8 days, P < .01;

Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction

30.1k vs

National trends in tongue reduction surgery for macroglossia in children

3.9k, P < .01), while LOS and cost for isolated macroglossia were similar to the general population. The rate of concurrent cardiac anomalies, cleft palate, and Down syndrome was increased in patients with macroglossia compared to unaffected newborns (P < .01). Rates of respiratory distress, feeding problems, GERD, endotracheal intubation, and prolonged ventilator support were higher in the syndromic group (P < .01). Newborns with isolated macroglossia suffered these conditions at the same rate as the general population. Conclusions: The birth prevalence of macroglossia varies by sex, race, and geographic location. Prolonged LOS and increased cost are associated with syndromic forms of macroglossia. Syndromic comorbidities rather than enlargement of the tongue in and of itself appear to be the chief contributors to increased LOS and cost in this population.

Weight Changes Immediately following Tonsillectomy

Objective: To determine which factors in the early neonatal period may predict subsequent need for surgical intervention in infants with micrognathia. Method: A retrospective case series of 123 infants from 2 tertiary pediatric referral centers over a 10-year period. Results: Forty-eight (39%) of micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of tracheostomy (n = 12), mandibular distraction osteogenesis (MDO) (n = 33), or prolonged intubation prior to withdrawal of care (n = 3). Factors associated with a need for definitive airway intervention included a history of intubation or tracheotomy in the first 24 hours of life (OR: 8.22; CI: 3.14-21.54), a history of intrauterine growth restriction (OR: 4.1; CI: 1.00-16.71), neurologic impairment (OR: 3.83; CI: 1.33-11.06), and prematurity (<37 weeks gestational age) (OR: 2.38; CI: 1.02-5.56). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR: 0.2; CI: 0.05-0.71). Conclusion: While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors, which may predict which neonates with micrognathia are at increased risk for requiring early surgical intervention for respiratory and feeding problems.