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W. Andrew Clement, FRCS(ORL); Hamdy El-Hakim, FRCS(ORL); Ernest Z. Phillipos, MD, FRCSC; Judith J. Coté, MN, NP, RN

Arch Otolaryngol Head Neck Surg. 2008;134(1):28-33.

Objective  To determine if unilateral vocal cord paralysis (UVCP) following patent ductus arteriosus (PDA) ligation is associated with respiratory and swallowing morbidities in extremely low-birth-weight (ELBW) infants.

Design  Case-control study.

Setting  Tertiary care neonatal intensive care units and pediatric hospital.

Participants  Twenty-three infants undergoing PDA ligation (subdivided into the main study group of 12 infants with UVCP and 11 without paralysis) and 12 weight- and gestational age–matched ELBW controls.

Main Outcome Measures  Incidence of UVCP, time requiring supplemental oxygen and ventilatory support, length of hospital stay, incidence and duration of tube feeding following discharge, and incidence of chronic lung disease.

Results  The overall incidence of UVCP was 52% (12/23), increasing to 67% (12/18) in ELBW infants. Infants without UVCP following PDA ligation were heavier (P = .006), with a more advanced gestational age (P = .03). Patients with UVCP required longer tube feeding (relative risk, 8.25; 95% confidence interval, 1.93-46.98; P = .003), supplemental oxygen (P = .004), and ventilatory support (P = .001) and had a longer hospital stay (P < .001). In comparison to matched controls, infants with UVCP required longer tube feeding (relative risk, 9.00; 95% confidence interval, 2.08-51.30; P = .003), supplemental oxygen (P = .03), and ventilatory support (P = .002) and had a longer hospital stay (P < .001).

Conclusions  There was a high incidence of occurrence of UVCP (67%) associated with PDA ligation in ELBW infants. Unilateral vocal cord paralysis following PDA ligation does seem to be associated with increased requirements for tube feeding, respiratory support, and hospital stay in these ELBW infants.

Author Affiliations: Department of Pediatric Surgery (Otolaryngology) (Drs Clement and El-Hakim) and David Schiff Neonatal Intensive Care Unit (Dr Phillipos), Stollery Children's Hospital, and Neonatal Intensive Care Unit, Royal Alexandra Hospital (Dr Phillipos and Ms Coté), Edmonton, Alberta, Canada.