Document Detail


Should all newborns who undergo patent ductus arteriosus ligation be examined for vocal fold mobility?
MedLine Citation:
PMID:  19507238     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Marshall E Smith; Jerald D King; Abdelaziz Elsherif; Harlan R Muntz; Albert H Park; Peter C Kouretas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Laryngoscope     Volume:  119     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-29     Completed Date:  2009-08-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1606-9     Citation Subset:  IM    
Affiliation:
University of Utah School of Medicine, Salt Lake City, USA. marshall.smith@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Decision Making
Ductus Arteriosus, Patent / surgery
Female
Humans
Infant, Newborn
Infant, Premature*
Intensive Care Units, Neonatal
Intraoperative Complications / diagnosis,  epidemiology,  etiology*
Intubation, Intratracheal / adverse effects,  methods
Laryngoscopy / methods
Ligation / adverse effects,  methods
Logistic Models
Male
Neonatal Screening / methods
Probability
Prognosis
Prospective Studies
Recurrent Laryngeal Nerve / injuries*
Risk Assessment
Severity of Illness Index
Vocal Cord Paralysis / diagnosis,  epidemiology*,  etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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