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Should all newborns who undergo patent ductus arteriosus ligation be examined for vocal fold mobility?

Authors

  • Marshall E. Smith MD,

    Corresponding author
    1. Division of Otolaryngology/Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
    2. Primary Children's Medical Center, Salt Lake City, Utah, U.S.A.
    • Division of Otolaryngology/Head and Neck Surgery, 3C-120 School of Medicine, 50 N. Medical Dr., Salt Lake City, UT 84132
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  • Jerald D. King MD,

    1. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
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  • Abdelaziz Elsherif MD,

    1. Division of Otolaryngology/Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
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  • Harlan R. Muntz MD,

    1. Division of Otolaryngology/Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
    2. Primary Children's Medical Center, Salt Lake City, Utah, U.S.A.
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  • Albert H. Park MD,

    1. Division of Otolaryngology/Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
    2. Primary Children's Medical Center, Salt Lake City, Utah, U.S.A.
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  • Peter C. Kouretas MD, PhD

    1. Division of Otolaryngology/Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
    2. Primary Children's Medical Center, Salt Lake City, Utah, U.S.A.
    3. Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
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  • Presented at the American Society of Pediatric Otolaryngology Annual Meeting, Orlando, Florida, U.S.A., May 2008. Received the Charles F. Ferguson Clinical Research Award, First Place.

Abstract

Objectives/Hypothesis:

To determine the incidence of left vocal fold paralysis (LVFP) in premature infants who undergo patent ductus arteriosus (PDA) ligation.

Study Design:

Prospective cohort.

Methods:

The study was carried out in the newborn intensive care unit (NICU) of a tertiary academic medical center. Eighty-six premature newborns who underwent ligation of a PDA were examined postextubation with fiberoptic laryngoscopy to assess vocal fold mobility, regardless of laryngeal symptom status.

Results:

Fourteen infants (16%) had LVFP. All were <28 weeks postmenstrual age (PMA) at birth and <1,250 g at PDA ligation, and were significantly less mature and smaller than infants without LVFP. Infants <28 weeks PMA at birth and <1,250 g at ligation had an incidence of LVFP of 23% and 24%, respectively. Fourteen percent of the infants with LVFP did not have laryngeal symptoms and would have been missed had these been the sole criteria for assessing vocal fold mobility.

Conclusions:

The incidence of LVFP after PDA ligation in the NICU is high, and some cases may be missed if laryngoscopy is performed only when laryngeal symptoms are present. Infants <28 weeks PMA at birth and <1,250 g at ligation are at especially high risk. Vocal fold mobility should be documented by laryngoscopy on all high-risk infants undergoing a PDA ligation in the NICU regardless of laryngeal symptom status, and on all infants with relevant symptoms. The high incidence of this complication warrants greater efforts to prospectively assess vocal fold mobility status in high-risk infants who undergo PDA ligation. Laryngoscope, 2009

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