Clinical characteristics and outcomes of neonates with bilateral vocal cord paralysis
- ZHANG Fengzhen, WANG Guixiang, ZHAO Jing, WANG Hua, DUAN Qingchuan, LI Hongbin, HEI Mingyan, WENG Jingwen, ZHANG Jie
Journal of Otolaryngology and Ophthalmology of Shandong University. 2022, 36(1):
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Objective The objective of this study is to investigate the etiology, clinical characteristics, treatment, and outcomes of bilateral vocal cord paralysis(BVCP)in neonates. Methods We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP by endoscopy at the Department of Neonatal Center between January 2016 and December 2020. We collected the information, etiology, treatment, and outcomes of the children. Follow-up sessions were conducted in the clinic or by telephone, and relevant information were recorded. Results This study included a total of 28 patients consisting of 18 males and 10 females. Their ages ranged from one to 24 days, with a median age of 3.5 days. The main findings can be summarized into three points. First, 92.9% of the neonates were full-term and 53.6% were born by caesarean delivery. The most common clinical symptoms were inspiratory stridor and dyspnea, present in 78.6% of patients. This was followed by aspiration and vomiting, which were present in 14.3% of patients. Second, the etiology was congenital in 82.1% and acquired in 17.9% of the infants. In the congenital BVCP cases, there were seven cases of congenital central nervous system diseases, six(21.4%)of congenital heart diseases, six(21.4%)of laryngotracheal diseases, and two(7.1%)of gastroesophageal reflux diseases. Most of the acquired factors were secondary to postoperative esophageal and tracheal diseases(75%). Third, among all the patients, eight(28.6%)underwent tracheotomy. Of the eight cases, one died, one(14.3%)was successfully extubated at the age of 12 months, one had the trachea blocked, and the remaining five cases have not recovered even after conducting follow-up sessions for 16-47 months. Among the remaining 20 patients waiting for observation, three cases died. Of the remaining 17 cases, 11(64.7%)cases recovered within 1-38 months of late follow-up, and six cases(35.3%)had improved vocal cord activity within 5-17 months of late follow-up. All in all, the follow-up time ranged from one month to four years, and four patients died. Conclusion BVCP in neonates is most commonly congenital in nature and has many comorbidity factors. Most of the clinical manifestations we observed were stridor, dyspnea, and occasionally, dysphagia. Tracheotomy is generally not necessary in treating neonatal BVCP. Most children with BVCP can recover by themselves and have good prognoses, so surgical intervention should not be done too early.