Left vocal cord paralysis after patent ductus arteriosus ligation: A systematic review

Area of Science:

• Neonatal Surgery
• Pediatric Cardiology
• Otolaryngology

Background:

• Extremely premature (EP) infants face a heightened risk of left vocal cord paralysis (LVCP) post-patent ductus arteriosus (PDA) surgery.
• The incidence and impact of LVCP in this vulnerable population require thorough investigation.

Purpose of the Study:

• To systematically review the incidence and outcomes of LVCP following PDA ligation in EP infants.
• To analyze factors influencing LVCP detection and its association with adverse events.

Main Methods:

• A systematic literature search was conducted across major databases (Cochrane, Medline, Embase, Cinahl, PsycInfo).
• Included studies focused on EP infants undergoing PDA surgery with reported LVCP incidence.
• Data extraction and synthesis employed random effect models; study quality was assessed using the Newcastle-Ottawa scale.

Main Results:

• The overall pooled incidence of LVCP was 9.0%, rising to 32% when only laryngoscopy-confirmed cases were considered.
• Infants with LVCP exhibited a significantly higher risk ratio for negative outcomes (2.20) compared to those without.
• A total of 21 publications involving 2067 infants were analyzed.

Conclusions:

• Wide variations in reported LVCP incidence may stem from differing study designs and lack of routine postoperative vocal cord assessment.
• LVCP is linked to adverse outcomes in EP infants, though long-term consequences remain poorly understood.
• Routine laryngoscopy is suggested for accurate LVCP identification and appropriate infant management.