Resolution of vocal fold immobility in preterm infants. Int J Pediatr Otorhinolaryngol 2017 Dec;103:83-86
Date
12/12/2017Pubmed ID
29224772DOI
10.1016/j.ijporl.2017.10.007Scopus ID
2-s2.0-85031278871 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
INTRODUCTION: Vocal fold immobility (VFI) is an important sequela of preterm birth due to patent ductus arteriosus (PDA) ligation and invasive ventilation. A minority of these patients experience VFI resolution. The purpose of this study is to determine factors associated with VFI resolution in preterm infants.
METHODS: This is a case control study of preterm (<37 weeks gestation) infants admitted to a metropolitan Level IV neonatal intensive care unit from 2006 to 2012. All patients diagnosed with VFI by flexible nasolaryngoscopy were divided into 2 cohorts: those with and without laryngoscopic resolution of VFI during follow-up. Univariate and multivariate analyses were performed to determine factors associated with VFI resolution.
RESULTS: Of 71 patients with VFI and adequate follow-up, 17 (23.9%) experienced resolution. Median (range) follow-up was 25.7 (0.4-91.3) months and time to resolution 4.4 (0.4-38.8) months. Compared to the ongoing-VFI cohort, those who experienced resolution had higher median gestational age (31 vs 25 weeks, p = 0.006) and birth weight (1550 vs 765 g, p = 0.02), and lower likelihood of undergoing PDA ligation (47.1% vs 77.8%, p = 0.02). On multivariate analysis, history of PDA ligation remained independently associated with a lower likelihood of VFI resolution (p = 0.02, OR 0.2, 95% CI 0.1-0.8). Among PDA ligation patients, birth weight >1000 g was more common in the resolution cohort compared to the ongoing-VFI cohort (62.5% vs 24.4%, p = 0.047).
CONCLUSION: While lower birth weight and gestational age are known risk factors for VFI following PDA ligation, in this study, these factors were also associated with a decreased likelihood of VFI resolution. Furthermore, PDA ligation appears to be a risk for both the development and persistence of VFI. This evidence should inform prognosis and intervention decisions for preterm infants with VFI.
Author List
Jabbour J, Robey TAuthor
Thomas C. Robey MD Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Case-Control StudiesDuctus Arteriosus, Patent
Female
Follow-Up Studies
Gestational Age
Humans
Infant
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Laryngoscopy
Ligation
Male
Postoperative Complications
Prognosis
Risk Factors
Vocal Cord Paralysis
Vocal Cords