Team Care in the NICU: Collaboration on Complex Cases, like Pierre Robin Sequence

It takes a true team to treat the clinical complexities present in the tiniest patients at Lehigh Valley Reilly Children's Hospital.

Two of them, twins Eva and Opal Bauer, were born in March 2021 with Pierre Robin sequence, a congenital condition characterized by an underdeveloped jaw, backward displacement of the tongue and upper airway obstruction.

“When you’re talking about respiratory distress and airway management, seconds matter,” says Wendy Kowalski, MD, Medical Director of the neonatal intensive care unit (NICU) at Lehigh Valley Reilly Children’s Hospital.

“The safest thing is to be in a hospital where clinicians are trained to care for and manage these patients.” 

The Level IV NICU at Lehigh Valley Reilly Children’s Hospital was up to the challenge, providing the Bauer family, from Fleetwood, Pa., with the highest level of care for the twins’ breathing and feeding difficulties.

Wellington Davis III, MD, Chief of Plastic Surgery, collaborated with Sri Chennupati, MD, Chief of the Department of Surgery, Division of Pediatric Surgical Specialties, Pediatric ENT, on evaluating the twins’ airway obstructions.

“When babies are born with a small jaw, as with this condition, this causes the tongue to sit back in the airway so they have respiratory problems,” Dr. Davis explains.

A multidisciplinary workup by NICU and ENT teams confirmed that a tongue-lip adhesion procedure was the optimal and least invasive intervention, as compared with tracheostomy or mandibular distraction. The Children’s Hospital offers a range of pediatric craniofacial services and employs a full-service cleft team.

“This procedure was the right decision. [The babies] could have stopped breathing at home without it,” Dr. Kowalski says.