title: Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation.
abstract: BACKGROUND
  The purpose of this study was to evaluate the incidence of vocal cord (VC) and swallowing dysfunction in infants after the Norwood operation and to examine the relationship between laryngopharyngeal dysfunction and postoperative outcomes.
  
  
  METHODS
  We conducted a retrospective review of 63 infants who underwent routine postoperative fiberoptic endoscopic evaluation of swallowing function and vocal cords after a Norwood operation at our institution during a recent 6-year period (2003-2009).
  
  
  RESULTS
  The overall incidence of VC dysfunction after the Norwood operation was 58.7%. After a modification of the aortic arch dissection technique in 2007, the incidence of VC dysfunction decreased significantly from 79.5% in 2003 through 2006 to 25% in 2007 through 2009 (p<0.001). The incidence of swallowing dysfunction also decreased from 23.1% in 2003 through 2006 to 4.2% in 2007 through 2009 (p=0.07). Swallowing dysfunction was more common in patients with VC dysfunction (21.6%) as compared with patients without VC dysfunction (7.7%; p=0.18). Patients with VC dysfunction were more often discharged home on tube-only feeding regimens compared with infants without VC dysfunction (46% versus 26.9%). In infants with both VC and swallowing dysfunction, 75% were discharged exclusively to have tube feeding. Median hospital length of stay tended to be longer in infants with swallowing dysfunction (31 days) than in infants without swallowing dysfunction (23 days; p=0.16).
  
  
  CONCLUSIONS
  Vocal cord and swallowing dysfunction are common in infants after the Norwood operation and may increase the need for tube feeding regimens. Modification of surgical techniques for dissection and mobilization of the aorta can significantly reduce the incidence of these adverse outcomes.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Averin
authors.forename: Karen
authors.initials: K
authors.lastname: Uzark
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.forename: J Paul
authors.initials: JP
authors.lastname: Willging
authors.forename: Jesse
authors.initials: J
authors.lastname: Pratt
authors.forename: Peter B
authors.initials: PB
authors.lastname: Manning
mesh_terms: D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007818:Laryngeal Diseases / Q000453:epidemiology* / Q000209:etiology; D058327:Norwood Procedures / Q000009:adverse effects*; D009820:Ohio / Q000453:epidemiology; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014826:Vocal Cord Paralysis / Q000453:epidemiology* / Q000209:etiology