Long-term follow-up of vocal fold movement impairment and feeding after neonatal cardiac surgery

Richter, Amy; Ongkasuwan, Julina; Ocampo, Elena C.

doi:10.1016/j.ijporl.2016.02.014

Cited by 26 publications

(32 citation statements)

References 9 publications

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“…Associated symptoms include dysphonia, dysphagia, aspiration, and occasionally respiratory problems in the absence of underlying pulmonary disease. In postcardiac surgery patients with UVFI, feeding issues may result in prolonged hospitalization, readmissions for poor feeding, and feeding tube dependence in the early postoperative period . Spontaneous recovery has been observed in patients with an anatomically intact recurrent laryngeal nerve, with reported time frames to recovery ranging from 6 months to 11 years…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

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Objective: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.Methods: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre-and postprocedure, incidence of aspiration-related sequelae, and adverse events.Results: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.Conclusion: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.

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Section: Introductionmentioning

confidence: 99%

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…Patients who have dysphagia after cardiac surgery have longer hospitalizations, are less likely to have an age-appropriate oral diet at discharge, and require more rehabilitative services as an outpatient. [14][15][16] Although Davies et al found significant intrinsic abnormalities in sensory and motor function and argue dysphagia exists independent of VFI in patients undergoing aortic arch augmentation via median sternotomy, dysphagia symptoms persist in 54% of patients with VFI making it challenging to separate the two as independent postoperative morbidities. 13 Some children with dysphagia due to VFI can be managed with a modified diet, but others require continued enteral feeding or a gastrostomy tube.…”

Section: Commentmentioning

confidence: 99%

Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations

Barr

Bowman

Deshpande

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Loss of laryngeal function after congenital cardiac surgery causes morbidity and prolongs hospitalization. Early diagnosis of vocal fold immobility (VFI) and referral to pediatric otolaryngology (pOTO) aids in laryngeal rehabilitation. Understanding the incidence and recovery rates of VFI enables counseling for families of infants undergoing high-risk surgery. Methods: A retrospective chart review from November 2014 to July 2019 of infants postcardiac surgery where the aortic arch or surrounding structures were manipulated and were screened via flexible fiberoptic laryngoscopy (FFL) at a single institution was performed. Patients were divided into five surgical categories: Norwood procedure, aortic arch augmentation via median sternotomy, arterial switch operation, coarctation repair via lateral thoracotomy, and cardiac surgeries including ligation of a patent ductus arteriosus (PDA). Patients undergoing isolated PDA ligation were excluded. Results: One hundred ninety-nine qualifying operations occurred during this period; 28 patients did not undergo FFL before discharge and were excluded from the analysis. Immediately following cardiac surgery, 34% (58 of 171 patients) had VFI. Follow-up was completed by 38 of 58 patients with VFI. Complete recovery was demonstrated in 63% (24 of 38) of patients by 6 months and in 86% (33 of 38) within 18 months. The highest risk occurred with the Norwood procedure and arch augmentation via median sternotomy. Conclusions: Infants undergoing surgery involving the aortic arch and surrounding structures have high rates of VFI. Follow-up by pOTO is recommended to optimize laryngeal rehabilitation. Most patients have spontaneous recovery within 18 months of cardiac surgery.

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“…Post-cardiac surgery, it is clear that children are at significant risk of aspiration (which could lead to pulmonary injury) and dysphagia due to vocal fold dysfunction [54,60,52]. Reports documenting post-operative occurrences are abundant yet there is a scarcity of data describing long-term follow-up [51,48,61]. The effects of dysphonia can be devastating for the social development of a child resulting in shyness, withdrawal at school, and general difficulty in engaging with others [8].…”

Section: Quality Of Life (Qol)mentioning

confidence: 99%

“…Supportive findings by Sachdeva et al [55] indicated that 87% (n=38) of VCP paediatric in their cohort were intolerant of full oral feeds at discharge and requiring modification to their nutritional intake, potentially with a modified delivery method. Recent findings from Richter et al [61] suggest that there is an expected time to regular oral feeding of less than 2 years irrespective of the infants' VCP status and genetic comorbidities. Despite the good prognosis, parents of VCP infants should be informed of modified diets at discharge and that there is a greater long-term risk for inpatient hospitalisation due to feeding difficulties and poor weight gain [61].…”

Section: Quality Of Life (Qol)mentioning

confidence: 99%

“…Recent findings from Richter et al [61] suggest that there is an expected time to regular oral feeding of less than 2 years irrespective of the infants' VCP status and genetic comorbidities. Despite the good prognosis, parents of VCP infants should be informed of modified diets at discharge and that there is a greater long-term risk for inpatient hospitalisation due to feeding difficulties and poor weight gain [61].…”

Section: Quality Of Life (Qol)mentioning

confidence: 99%

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

et al. 2021

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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.

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Long-term follow-up of vocal fold movement impairment and feeding after neonatal cardiac surgery

Cited by 26 publications

References 9 publications

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations

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

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