A newborn has severe micrognathia, glossoptosis with episodic cyanosis when supine, and a U-shaped cleft of the soft palate. During one episode the infant becomes dusky and desaturates. What is the most appropriate immediate first step in management?

• A Immediate tracheostomy
• B Prone positioning with jaw thrust support ✓
• C Endotracheal intubation via laryngoscopy
• D Uvulopalatopharyngoplasty

Explanation

This is Pierre Robin sequence: micrognathia displaces the tongue posteriorly, obstructing the airway, classically with a U-shaped cleft palate. Obstruction is positional, so the first step is placing the infant prone, often combined with a nasopharyngeal airway, which relieves glossoptosis by letting the tongue fall forward. Intubation can be difficult because of the small jaw, and tracheostomy is reserved for failure of conservative measures such as positioning, nasopharyngeal tube, or tongue-lip adhesion.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.