Micrognathia-Retrognathia Clinical Pathway — N/IICU and ICU

Pre/Post-Operative Care

Refer to N/IICU Clinical Pathway for Perioperative Care of Newborn/Infants

Pre-Operative Care

Bathing	Bathing Recommendations for Reducing Central Line Associated Bloodstream (CLABSI) and Surgical Site Infections (SSI) Job Aid
Pre-Operative Antibiotics	No MRSA colonization: Cefazolin MRSA colonization: Vancomycin

Post-Operative Care

Post-Operative Antibiotics	Continue pre-operative antibiotics 48 hrs after surgery Consult Infectious Disease if antibiotics are needed longer
Analgesia	Consider pre-medicating prior to turning distractors Wean pain medications once distractors are no longer being turned Refer to Perioperative Pain Guidelines, N/IICU Clinical Pathway for Perioperative Care of Newborns/Infants
Distractor Arm Care	Clean site using sterile water and cotton tip applicators Mepilex Mepilex is placed under all distractors in the operating room Esure that Mepilex is placed under all distractors, all the way to the insertion site Change as needed for drainage, routine cleaning and turning Discontinue use of Mepilex when: Arms of the distractor are removed after turning Remaining hardware is not long enough to keep Mepilex in place If discharging home with the distractor arms still in place and parents will be turning, notify Case Management to order Mepilex supplies for home
Topical Antibiotic Ointment	Apply topical antibiotic ointment to distractor pin sites twice daily No MSSA or MRSA colonization: Bacitracin-Polymixin B MSSA or MRSA colonization: Mupirocin Once distractor pins are removed and the skin has healed over the site, antibiotic ointment can be discontinued
Turning Distractors	Turn per order from Plastic Surgery Mandibular Distraction Turning Job Aid
Imaging	Serial X-ray Skull 2 View PA/Lateral to assess for mandibular changes
Respiratory Evaluation	Repeat sleep study prior to discharge

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Micrognathia-Retrognathia Clinical Pathway — N/IICU and ICU

Pre/Post-Operative Care

Pre-Operative Care

Post-Operative Care

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Innovation and your child

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Micrognathia-Retrognathia, Newborn/Infant Clinical Pathway, N/IICU – Pre/Post-Operative Care

Micrognathia-Retrognathia Clinical Pathway — N/IICU and ICU

Pre/Post-Operative Care

Pre-Operative Care

Post-Operative Care