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Long-term Outcomes of Vocal Fold Paralysis Following Patent Ductus Arteriosus Ligation in Neonates
Quinn Orb1, Gabriel Dunya1, Reema Padia2
1Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Insights
Patent ductus arteriosus (PDA) ligation can cause left vocal fold paralysis (LVFP) in infants, especially premature ones. While many infants recover, some require interventions, highlighting the need for ongoing monitoring.
Area of Science:
- Neonatal surgery
- Pediatric otolaryngology
- Vocal cord function
Background:
- Patent ductus arteriosus (PDA) ligation is a common procedure in neonates.
- Left vocal fold paralysis (LVFP) is a known complication, particularly in premature infants.
- Understanding the incidence and long-term outcomes of LVFP is crucial for patient management.
Purpose of the Study:
- To determine the incidence of LVFP following PDA ligation in infants.
- To report on the long-term outcomes for infants who develop LVFP after PDA ligation.
Main Methods:
- A prospective study was conducted on infants undergoing PDA ligation between 2004 and 2014.
- Flexible laryngoscopy was used to assess vocal fold mobility post-procedure.
- Patients were followed longitudinally to evaluate long-term outcomes.
Main Results:
- 36 out of 163 infants (22%) developed LVFP post-PDA ligation.
- LVFP incidence was higher in neonates <1500g (25%) compared to those >1500g (5%).
- Infants with LVFP had increased need for feeding tubes and longer NICU stays; long-term follow-up showed varied recovery.
Conclusions:
- The incidence of LVFP after PDA ligation is significant, especially in extremely low birth weight infants.
- Most patients recover over time, but some require surgical intervention for persistent issues.
- Long-term follow-up is essential to monitor and ensure improvement in patients with LVFP.
Introduction:
In patients undergoing patent ductus arteriosus (PDA) ligation there is a significant risk of left vocal fold paralysis (LVFP) particularly in premature neonates who are small for gestational age. The objective of this study is to determine the incidence of LVFP in infants following PDA ligation and report on long-term outcomes in patients with LVFP.
Methods:
We performed a prospective study of patients undergoing PDA ligation in the newborn intensive care unit (NICU) between April 2004 and May 2014. Following PDA ligation, flexible laryngoscopy was performed to assess vocal fold mobility. Patients were then followed longitudinally to determine long-term outcomes.
Results:
A total of 163 infants underwent PDA ligation. Thirty-six patients (22%) developed LVFP following the procedure. Twenty-five percent of neonates <1500 g experienced LVFP versus 5% of patients >1500 g (p = 0.033). Patients with LVFP were more likely to require a feeding tube (64% vs. 19.6%; p < 0.05) and spent more time in the NICU (135 days vs. 106 days; p < 0.05). Twenty-four patients received long-term follow-up. Six (25%) had complete resolution of LVFP, 10 (42%) were compensated, and 8 (33%) demonstrated persistent LVFP with no improvement.
Conclusions:
The incidence of LVFP after PDA ligation is high especially in extremely low birth weight children. The majority of patients recovered well with time, but further surgical intervention was required in uncompensated cases. Long-term follow-up of these patients is needed to ensure improvement. Laryngoscope, 133:1257-1261, 2023.
