Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • 20th Anniversary Special Edition
    • Topic/Program Collections
    • Blog
    • Questions from NeoReviews
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
    • NeoReviewsPlus
    • Board Review Study Guide
  • Multimedia
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • 20th Anniversary Special Edition
    • Topic/Program Collections
    • Blog
    • Questions from NeoReviews
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
    • NeoReviewsPlus
    • Board Review Study Guide
  • Multimedia
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Complex Fetal Care

Fetal Micrognathia and Airway Establishment on Placental Support

Stefanie Riddle, Foong Yen Lim, Michael Rutter, Howard M. Saal and Paul Kingma
NeoReviews January 2021, 22 (1) e73-e77; DOI: https://doi.org/10.1542/neo.22-1-e73
Stefanie Riddle
*Cincinnati Fetal Center, Cincinnati, OH
†Division of Neonatology, Cincinnati Children’s Hospital Cincinnati, OH
‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Foong Yen Lim
*Cincinnati Fetal Center, Cincinnati, OH
§Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital, Cincinnati, OH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Rutter
¶Division of Otolaryngology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Howard M. Saal
‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
‖Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul Kingma
*Cincinnati Fetal Center, Cincinnati, OH
†Division of Neonatology, Cincinnati Children’s Hospital Cincinnati, OH
‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF
  • Abbreviations:
    ETT:
    endotracheal tube
    EXIT:
    ex utero intrapartum treatment
    POPS:
    procedure on placental support
  • Case Presentation

    A 36-year-old gravida 3, para 2-0-0-2 pregnant woman was referred to our fetal care center at 20 5/7 weeks’ gestation because of fetal micrognathia, lagging femur length, and a single umbilical artery. Her pertinent medical and surgical histories included asthma and a prior cesarean section. The pregnancy was the product of in vitro fertilization. Preimplantation genetic screening demonstrated an embryo with a normal karyotype. Her medications included fluticasone propionate/salmeterol, montelukast, lansoprazole, and prenatal vitamins. Family history revealed 2 paternal female first cousins once removed with Smith-Lemli-Opitz syndrome and seizure disorder related to sodium channelopathy. Her standard prenatal screening results were unremarkable.

    Evaluation at our fetal care center included the following:

    • Fetal echocardiography: Normal cardiac anatomy and function.

    • Fetal magnetic resonance imaging (MRI; Fig 1): Normal brain anatomy with normally shaped calvarium. Head circumference lagging 2 weeks behind stated gestational age. Glossoptosis with narrowing of the nasopharyngeal and oropharyngeal airway without cleft palate. The philtrum appeared elongated. Micrognathia was noted, with a jaw index of 14.3 (calculated by measuring the anteroposterior mandibular diameter divided by the biparietal diameter and multiplied by 100; a jaw index <23 is predictive of clinically significant micrognathia). The stomach was mildly small throughout the examination, likely secondary to impaired fetal swallowing. Amniotic fluid was subjectively increased.

    • Transabdominal ultrasonography: Micrognathia with mandibular retrognathia; jaw index 17 (note: a discrepancy can occur in jaw index measurement with MRI vs ultrasonography); single umbilical artery. Fetal biometry was notable for a lagging femur length (4th percentile) and head circumference (<3rd percentile). Amniotic fluid was subjectively increased.

    Figure 1.

    Fetal magnetic resonance imaging scan obtained at 20 weeks’ gestation. A. The abnormal facial profile with severe micrognathia. B. Facial profile; white arrow indicates glossoptosis.

    Expert Opinion

    The conglomeration of these fetal findings is consistent with a diagnosis of Pierre Robin sequence. Pierre Robin sequence occurs …

    Individual Login

    Log in
    You will be redirected to aap.org to login or to create your account.

    Institutional Login

    via Institution

    You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.

    Log in through your institution

    If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.

    Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00

    Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.

    Offer Reprints

    Previous
    Back to top

    Advertising Disclaimer »

    In this issue

    NeoReviews
    Vol. 22, Issue 1
    1 Jan 2021
    • Table of Contents
    • Table of Contents (PDF)
    • Index by author
    • Complete Issue (PDF)
    View this article with LENS
    Previous
    Email Article

    Thank you for your interest in spreading the word on American Academy of Pediatrics.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Fetal Micrognathia and Airway Establishment on Placental Support
    (Your Name) has sent you a message from American Academy of Pediatrics
    (Your Name) thought you would like to see the American Academy of Pediatrics web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Request Permissions
    Article Alerts
    Log in
    You will be redirected to aap.org to login or to create your account.
    Or Sign In to Email Alerts with your Email Address
    Citation Tools
    Fetal Micrognathia and Airway Establishment on Placental Support
    Stefanie Riddle, Foong Yen Lim, Michael Rutter, Howard M. Saal, Paul Kingma
    NeoReviews Jan 2021, 22 (1) e73-e77; DOI: 10.1542/neo.22-1-e73

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Share
    Fetal Micrognathia and Airway Establishment on Placental Support
    Stefanie Riddle, Foong Yen Lim, Michael Rutter, Howard M. Saal, Paul Kingma
    NeoReviews Jan 2021, 22 (1) e73-e77; DOI: 10.1542/neo.22-1-e73
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    Print
    Download PDF
    Insight Alerts
    • Table of Contents

    Jump to section

    • Article
      • Case Presentation
      • Expert Opinion
      • Outcome
      • Neonatal Course
      • Discussion
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • Comments

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Cited By...

    • No citing articles found.
    • Google Scholar

    More in this TOC Section

    • Vein of Galen Malformation
    • Complex Fetal Care Case: Amniotic Fluid Replacement in Severe Bladder Outlet Obstruction
    Show more Complex Fetal Care

    Similar Articles

    • Journal Info
    • Editorial Board
    • Overview
    • Licensing Information
    • Authors/Reviewers
    • Author Guidelines
    • Submit My Manuscript
    • Librarians
    • Institutional Subscriptions
    • Usage Stats
    • Support
    • Contact Us
    • Subscribe
    • Resources
    • Media Kit
    • About
    • NeoReviewsPlus
    • International Access
    • Terms of Use
    • Privacy Statement
    • FAQ
    • AAP.org
    • shopAAP
    • Follow American Academy of Pediatrics on Instagram
    • Visit American Academy of Pediatrics on Facebook
    • Follow American Academy of Pediatrics on Twitter
    • Follow American Academy of Pediatrics on Youtube
    • RSS
    • NeoReviews® and NeoReviewsPlus™ are supported, in part, through an educational grant from Abbott Nutrition, a division of Abbott Laboratories, Inc.
    American Academy of Pediatrics

    © 2021 American Academy of Pediatrics