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Our group has developed and implemented a treatment protocol consisting of an individualized orthodontic appliance (Tuebingen Palate Plate (TPP)), feeding training and orofacial stimulation therapy, which addresses the two main clinical problems in RS, i.e. However, their impact on weight gain has not yet been adequately studied or compared.
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Treatment protocols vary widely in RS, ranging from non-surgical (e.g., prone positioning, insertion of a nasopharyngeal tube or continuous positive airway pressure) to operative procedures (e.g., tongue-lip adhesion, mandibular distraction osteogenesis or tracheostomy). Therefore, identification and subsequent treatment of upper airway obstruction and feeding difficulties is particularly important in RS, especially since failure to thrive is associated with impaired neurodevelopment, at least in preterm infants. Malnutrition is defined as an imbalance between nutrient requirements and intake that results in cumulative deficiencies in energy, protein or micronutrients that can negatively impact growth, development and other relevant outcomes. Impaired weight gain in the first postnatal months has been reported in several studies on RS. Besides these functional impairments, growth retardation may also be related to an underlying syndrome, chromosomal or other abnormalities that occur in up to 50% or RS infants. Further, infant feeding requires a complex coordination between breathing, sucking, and swallowing, which can be disrupted by neurologic problems also seen in some infants with RS. As a result, the vast majority of mothers of babies with RS are unable to breastfeed, and alternative feeding techniques often result in inadequate nutrient intake, so that reported rates of poor feeding in infants with RS range from 47 to 100%. It often also prevents achieving a sufficient oral vacuum for adequate sucking. In cleft palate, which is present in 80–90% of RS infants, severity and size of the cleft usually correspond to the degree of feeding difficulties, because the wider the cleft palate, the smaller the area available for serving as an abutment for the nipple. For example, glossoptosis may prevent placing the nipple on the body of the tongue during feeding, which together with mandibular micrognathia and an upper-lower jaw discrepancy may inhibit development of an efficient sucking pattern. UAO results in an elevated energy expenditure due to an increased work of breathing, which is the main cause of growth failure in RS, being further aggravated by feeding difficulties resulting from the characteristic anatomy. For several reasons, it also often leads to growth failure. Robin sequence (RS), consisting of mandibular retrognathia, glossoptosis, upper airway obstruction (UAO) and optionally cleft palate, has an estimated birth prevalence of 1:8500–1:14,000. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.