title: Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants.
abstract: OBJECTIVE
  Determine associations between left vocal cord paralysis (LVCP) and poor respiratory, feeding and/or developmental outcomes in extremely low birth weight (ELBW) infants following surgical closure of a patent ductus arteriosus (PDA).
  
  
  METHODS
  ELBW infants who underwent PDA ligation between January 2004 and December 2006 were identified. We compared infants with and without LVCP following ligation to determine relationships between LVCP and respiratory morbidities, feeding and growth difficulties and neurodevelopmental impairment at 18 to 22-month follow-up. Student's t-test, Fisher's exact test and multivariable regression analyses were used to determine associations.
  
  
  RESULTS
  In all, 60 ELBW infants with a mean gestational age of 25 weeks and mean birth weight of 725 g had a PDA surgically closed. Twenty-two of 55 survivors (40%) were diagnosed with LVCP post-operatively. Infants with LVCP were significantly more likely to develop bronchopulmonary dysplasia (82 vs 39%, P=0.002), reactive airway disease (86 vs 33%, P<0.0001), or need for gastrostomy tube (63 vs 6%, P<0.0001).
  
  
  CONCLUSIONS
  LVCP as a complication of surgical ductal ligation in ELBW infants is associated with persistent respiratory and feeding problems. Direct laryngoscopy should be considered for all infants who experience persistent respiratory and/or feeding difficulties following PDA ligation.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Jean and George Brumley Jr. Neonatal Perinatal Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Benjamin
authors.forename: P B
authors.initials: PB
authors.lastname: Smith
authors.forename: C M
authors.initials: CM
authors.lastname: Cotten
authors.forename: J
authors.initials: J
authors.lastname: Jaggers
authors.forename: R F
authors.initials: RF
authors.lastname: Goldstein
authors.forename: W F
authors.initials: WF
authors.lastname: Malcolm
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000209:etiology*; D002658:Developmental Disabilities / Q000150:complications / Q000209:etiology; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000209:etiology*; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008026:Ligation / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D061226:Recurrent Laryngeal Nerve Injuries; D014826:Vocal Cord Paralysis / Q000150:complications / Q000209:etiology*