scholarly journals Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort

2020 ◽  
pp. 000348942095037
Author(s):  
Stephen R. Chorney ◽  
Karen B. Zur ◽  
Adva Buzi ◽  
Margo K. McKenna Benoit ◽  
Sri K. Chennupati ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Prospective Cohort ◽  
Ductus Arteriosus ◽  
Preterm Neonates ◽  
Level Of Evidence ◽  
Video Recordings ◽  
Pda Ligation ◽  
Postmenstrual Age ◽  
Bedside Diagnosis ◽  
Gestational Age At Birth

Objective: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. Methods: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. Results: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) ( P = .56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa = .75), with 91.9% agreement. Conclusion: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. Level of Evidence 2b

scholarly journals Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jonathan L. Slaughter ◽  
Clifford L. Cua ◽  
Jennifer L. Notestine ◽  
Brian K. Rivera ◽  
Laura Marzec ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Brain Natriuretic Peptide ◽  
Preterm Infants ◽  
Prospective Cohort ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Delay ◽  
Ductal Closure ◽  
Postmenstrual Age ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm. Methods Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort. Discussion The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in “high-risk” infants most likely to receive benefit. Trial registration ClinicalTrials.gov NCT03782610. Registered 20 December 2018.

scholarly journals A Simple Non-Invasive Biomarker Can Reflect Both the Acute and Chronic Pulmonary Impact of Patent Ductus Arteriosus (PDA) Shunting

2022 ◽  
Author(s):  
Alona Bin-Nun ◽  
Irina Shchors ◽  
Rawan Abu-Omar ◽  
Yair Kasirer ◽  
Francis Mimouni ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Oxygen Diffusion ◽  
Ductus Arteriosus ◽  
Curve Analysis ◽  
Preterm Neonates ◽  
Roc Curve Analysis ◽  
Time Points ◽  
Non Invasive ◽  
Postmenstrual Age ◽  
Patent Ductus

The SFR (Sp02/Fi02 ratio) offers a continuous, non-invasive reflection of pulmonary function regardless of whether the baby is ventilated or breathing spontaneously. We hypothesized that significant PDA shunting would impair pulmonary oxygen diffusion, in turn, reflected by decreased SFR; and that early PDA related decreases in SFR will predict subsequent chronic lung disease (CLD). Methods: We retrospectively examined records from preterm neonates <30 weeks gestational age. Ductal shunting was graded for severity by first week echocardiogram. SFR was calculated as SpO2/Fi02 and recorded on day 7 of life and at 36 weeks postmenstrual age (PMA). Results: We studied 104 infants: 65 with closed duct; 17 with hemodynamically insignificant PDA and 22 with hemodynamically significant (hsPDAs). CLD developed in 9 (14%) of those with closed ducts; 6 (35%) of those with hisPDA; and in 12 (55%) of those with hsPDA (p=0.005). Babies with hsPDA had significantly lower SFR values at both time points. SFRs in babies with hisPDA were decreased at 1 week postnatally, but were similar to those of babies with closed ducts at 36 weeks. SFR at 36 wks. was decreased only in infants with hsPDA [[467[461,467] vs. 467[413,471] vs. 369[262,436] respectively; p=0.000148]. Using ROC curve analysis, week 1 SFR was strongly associated with hsPDA (AUC=0.770; p<0.0001) and highly predictive (AUC=0.801; p<0.0001) of CLD at 36 weeks PMA. Conclusion: Early decreases in SFR reflect both the acute and chronic pulmonary impact of PDA shunting, possibly providing the missing link supporting an association between hemodynamically significant PDA and subsequent CLD.

scholarly journals Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

2021 ◽  
pp. 1-9
Author(s):  
Aditi Sinha ◽  
Alexander Geragotellis ◽  
Guntaj Kaur Singh ◽  
Devika Verma ◽  
Daniyal Matin Ansari ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Vocal Cord ◽  
Vocal Fold ◽  
Heart Surgery ◽  
Vocal Cord Palsy ◽  
Standards Of Care ◽  
Management Options ◽  
Paediatric Cardiac Surgery ◽  
Cord Injury ◽  
Pda Ligation

Abstract Background: Vocal cord palsy is one of the recognised complications of complex cardiac surgery in the paediatric population. While there is an abundance of literature highlighting the presence of this complication, there is a scarcity of research focusing on the pathophysiology, presentation, diagnosis, and treatment options available for children affected by vocal cord palsy. Materials and methods: Electronic searches were conducted using the search terms: “Vocal Cord Palsy,” “VCP,” “Vocal Cord Injury,” “Paediatric Heart Surgery,” “Congenital Heart Surgery,” “Pediatric Heart Surgery,” “Vocal Fold Movement Impairment,” “VFMI,” “Vocal Fold Palsy,” “PDA Ligation.” The inclusion criteria were any articles discussing the outcomes of vocal cord palsy following paediatric cardiac surgery. Results: The two main populations affected by vocal cord palsy are children undergoing aortic arch surgery or those undergoing PDA ligation. There is paucity of prospective follow-up studies; it is therefore difficult to reliably assess the current approaches and the long-term implications of management options. Conclusion: Vocal cord palsy can be a devastating complication following cardiac surgery, which if left untreated, could potentially result in debilitation of quality of life and in severe circumstances could even lead to death. Currently, there is not enough high-quality evidence in the literature to aid recognition, diagnosis, and management leaving clinicians to extrapolate evidence from adult studies to make clinical judgements. Future research with a focus on the paediatric perspective is necessary in providing evidence for good standards of care.

Comparison of Prophylaxis and Rescue Treatment With Curosurf in Neonates Less than 30 Weeks' Gestation: A Randomized Trial

PEDIATRICS ◽  
1993 ◽  
Vol 92 (6) ◽  
pp. 768-774 ◽  
Author(s):  
Johannes Egberts ◽  
J. Peter de Winter ◽  
Gunnar Sedin ◽  
Martin J.K. de Kleine ◽  
Ulf Broberger ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Expectant Management ◽  
Supplemental Oxygen ◽  
Preterm Neonates ◽  
Transcutaneous Oxygen ◽  
Prophylaxis Group ◽  
Rescue Treatment

Objective. The aim of this randomized clinical trial was to evaluate the immediate effects of prophylactic administration of Curosurf and to compare outcomes after prophylactic or expectant management. Study design. Porcine surfactant (Curosurf, 200 mg/kg body weight) was administered intratracheally within 10 minutes of birth to preterm neonates with a gestational age of 26 to 29 weeks (n = 75); rescue-eligible neonates (n = 72) were initially subjected to a sham maneuver. The primary end points of the trial, evaluated at the age of 6 hours, were to obtain (1) a 40% decrease in the ratio between transcutaneous oxygen tension (tcPo2) (kPa) and fraction of inspired oxygen (Fio2), and (2) a 50% decrease in the incidence of radiologically verified respiratory distress syndrome (RDS). After 6 to 24 hours, a similar dose of surfactant was given to the neonates of both the prophylaxis and the rescue-eligible group, if they needed mechanical ventilation with an Fio2 ≥ 0.6. Results. At 6 hours the prophylaxis group had, in comparison with the rescue-eligible group, significantly higher tcPo2/Fio2 ratios (mean ± SD: 39.7 ± 15.3 vs 28.1 ± 18.1; P &lt; .001) and less severe RDS by radiological scoring (χ2 = 14.9; P = .005). Severe RDS was present in 19% of the prophylactically treated neonates versus 32% in the rescue-eligible group (P &lt; .05). The prophylaxis group needed shorter periods of Fio2 &gt; 0.40 than the rescueeligible neonates (P &lt; .01), and eight neonates of the prophylaxis group (11%) versus 23 of the rescue-eligible group (32%) qualified for rescue treatment with surfactant in the interval 6 to 24 hours (P &lt; .01). There were no differences in the incidence or severity of pneumothorax, pulmonary interstitial emphysema, cerebral hemorrhage, periventricular leukomalacia, patent ductus arteriosus, in the duration of mechanical ventilation or time in supplemental oxygen, or in mortality. Conclusions. Subgroup analysis revealed (1) that administration of corticosteroids reduced the risk of developing neonatal RDS as effectively as did surfactant prophylaxis at birth, and (2) that prophylaxis was effective especially in neonates with gestational age &lt;28 weeks or birth weight &lt;1000 g, in male neonates, and in neonates who had received no antenatal treatment with corticosteriods. Our data indicate that prophylactic treatment with surfactant should be considered in high-risk neonates fulfilling these latter criteria.

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