Long-term Outcomes of Vocal Fold Paralysis Following Patent Ductus Arteriosus Ligation in Neonates.

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.

Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates.

BACKGROUND AND OBJECTIVE: Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the NICU. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (nCPAP) for noninvasive respiratory support in the NICU. METHODS: Randomized, controlled, unblinded noncrossover trial in 432 infants ranging from 28 to 42 weeks' gestational age with planned nCPAP support, as either primary therapy or postextubation. The primary outcome was defined as a need for intubation within 72 hours of applied noninvasive therapy. RESULTS: There was no difference in early failure for HHHFNC (23/212 [10.8%]) versus nCPAP (18/220 [8.2%]; P = .344), subsequent need for any intubation (32/212 [15.1%] vs 25/220 [11.4%]; P = .252), or in any of several adverse outcomes analyzed, including air leak. HHHFNC infants remained on the study mode significantly longer than nCPAP infants (median: 4 vs 2 days, respectively; P < .01), but there were no differences between study groups for days on supplemental oxygen (median: 10 vs 8 days), bronchopulmonary dysplasia (20% vs 16%), or discharge from the hospital on oxygen (19% vs 18%). CONCLUSIONS: Among infants ≥28 weeks' gestational age, HHHFNC appears to have similar efficacy and safety to nCPAP when applied immediately postextubation or early as initial noninvasive support for respiratory dysfunction.

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

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.

Aspergillosis in a 24-week newborn: a case report.

Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.