Neonatal management

Neonatal management

In the neonatal period management is aimed at addressing the urgent issues relating to the airway , breathing, eye protection and establishing feeding. In many of the craniofacial conditions the airway can be a ff ected and may be fully or partially obstructed. This may be because of a retropositioned hypoplastic maxilla – the tongue falling back to close o ff the upper airway; this is often com - pounded b y a hypoplastic mandible. The trachea itself may also be abnormal and tracheomalacia can lead to respiratory problems. Neonates are obligate nasal breathers and some forms of nasal obstruction can pr ecipitate airway symptoms. In the most severe cases intubation is not possible as a result of the abnormal anatomy and a tracheostomy may be necessary . In emergency situations it may be helpful to nurse the baby prone, allowing the tongue to fall forwards. In some cases, particularly the syndromic craniosynostoses such as Apert syndrome, Pfei ff er syndrome or Crouzon syndrome, the combination of midface retrusion and brachycephalic forehead shape can lead to severe exorbitism. In the worst cases this can cause ocular dislocation with the eyelids closing behind the globe. In severe exorbitism the eyelids do not close adequately to moisturise and protect the cornea; without intervention this may lead to irreversible corneal damage. In neonates with airway embarrassment, even without ana - tomical abnormalities, the e ff ort of breathing can be exhaust - ing and this can significantly compromise the ability to feed. Structural anomalies can also a ff ect the ability to feed; expert input from a specialist feeding nurse is often helpful. The use of specialised teats may be helpful but in some cases naso- or orogastric feeding may be necessary . -