Difficult Intubation in Syndromic Children: The Role of Phenotype and The History of Early Life

Background and Aims: Craniofacial features and comorbidities may complicate airway management in syndromic children. At the same time, it is uncertain whether a diagnosis of a syndrome predicts intubation difficulty. In this study, we aimed to analyze the frequency of intubation difficulty in syndromic children who underwent dental surgery and the clinical features associated with intubation difficulty.
Methods: In this single-center, retrospective, observational study, 58 children younger than 18 years were evaluated. Demographic features, ASA class, comorbidities, airway phenotype, history of stay in the neonatal ICU, number of intubation attempts, Cormack–Lehane class, and SpO₂ were recorded. Groups were compared using the Mann–Whitney U test and Fisher’s exact test.
Results: A short neck was found in 29 (50.0%), a small jaw in 31 (53.4%), a large tongue in 40 (69.0%), and a history of neonatal ICU stay in 31 (53.4%) children. Difficult intubation was recorded in seven children (12.1%). In the difficult intubation group, the number of intubation attempts [2 (2–3) vs. 1 (1–3), p<0.001], Cormack–Lehane score [3 (3–4) vs. 1 (1–3), p<0.001], and minimum SpO₂ [93% (90–95) vs. 98% (96–99), p<0.001] were more unfavorable.
Conclusion: Intubation difficulty was observed in 12.1% of this selected syndromic pediatric group. Although micrognathia, short neck, and macroglossia were observed more frequently in the difficult intubation group, the sample size limited the ability to establish these variants as statistically significant findings.