Plastic and Reconstructive Surgery, Global Open (May 2025)

Standardized Classification of Infants With Robin Sequence Using MicroNAPS: The Impact of Syndromes and Comorbidities

  • Cory M. Resnick, MD, DMD,
  • Jody E. Heffernan, RN, MSN, NNP-BC,
  • Snigdha Jindal, MPH,
  • Zaara Mehra,
  • Irfan Ahmad, MD,
  • Bimal Chaudhari, MD, MPH,
  • Christopher Cielo, DO,
  • Nicole Deptula, MD,
  • Zarmina Ehsan, MD,
  • Kelly N. Evans, MD,
  • Semsa Gogcu, MD, MPH,
  • Scott E. Hickey, MD,
  • Jeffrey S. Marschall, DMD, MD,
  • Maithilee Menezes, MD,
  • David Molter, MD,
  • Michael A. Padula, MD,
  • Stacey L. Peterson-Carmichael, MD,
  • Stephen Alex Rottgers, MD,
  • Christopher M. Runyan, MD, PhD,
  • Jordan W. Swanson, MD,
  • Tara L. Wenger, MD, PhD,
  • Andrew Deek, MD, DDS,
  • on behalf of the Children’s Hospital Neonatal Consortium

DOI
https://doi.org/10.1097/GOX.0000000000006734
Journal volume & issue
Vol. 13, no. 5
p. e6734

Abstract

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Background:. MicroNAPS, a classification for infants with Robin sequence (RS) intended to guide treatment decisions, consists of 5 elements: micrognathia, nutrition, airway, palatal clefting, and syndromes/comorbidities. Scoring of the first 4 elements is well defined, but the assignment of the syndromes/comorbidities score (S score) introduces subjectivity by necessitating judgment regarding the clinical impact of the diagnosis. A database of comorbid diagnoses associated with RS and consensus-based S scores for each is needed for the MicroNAPS system to be reproducible. Methods:. Diagnoses known to be associated with RS were identified from existing literature, and preliminary severity grades were applied. A series of electronic surveys were distributed to RS experts seeking agreement or recommendation and explanation for updated scoring, according to the Delphi technique, until at least 75% consensus was achieved for each item. A previously published series of 100 infants was rescored according to the resulting grades, and changes from initial scoring were assessed. Results:. A total of 170 associated syndromes and comorbidities were identified. Complete responses were received from 20 of the 35 experts (57.1%) surveyed. Consensus on S scores was achieved for all but 3 diagnoses (98.2%) after 4 rounds of surveys. Rescoring of the published series found 25 (25%) changes in S scores resulting in 5 modifications to R stages. Conclusions:. We have compiled a comprehensive list of syndromes and comorbid diagnoses associated with RS and achieved expert consensus regarding the impact on early treatment decision-making for most. This list, assigned S scores, and a complete MicroNAPS calculator are publicly available at www.prscalculator.com.