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Siu JM, Colyer J, Horner C, Bhat A, Bohuta L, Chan T, Dahl JP, Fridgen J, Johnson K, Yip C, Parikh SR. Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration. Laryngoscope 2024; 134:1939-1944. [PMID: 37615373 DOI: 10.1002/lary.31000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/09/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Vocal fold motion impairment (VFMI) is a known consequence after high-risk cardiac surgery. We implemented a universal laryngeal ultrasound (LUS) screening protocol for VFMI after the Norwood and aortic arch surgery. We hypothesized that LUS would accurately identify VFMI and predict postoperative aspiration. METHODS We implemented a screening algorithm with LUS for patients undergoing high-risk cardiac surgery at a tertiary care pediatric hospital. Positively screened patients underwent flexible nasolaryngoscopy (FNL). Patients with an abnormal FNL underwent a video-fluoroscopic swallow study (VFSS). Patient demographics, length of stay, and swallowing outcomes were assessed. Two-tailed chi square and Wilcoxon rank sum tests were used to assess for differences. RESULTS Sixty-seven patients underwent either Norwood or arch reconstruction over a 16-month period and underwent universal LUS. The average birth weight was 3.24 kg (SD 0.57). Of the 67 patients, VFMI was identified by LUS and 100% confirmed on FNL in 58.21% (n = 39/67) of patients. Aspiration and penetration on VFSS were higher in the group with VFMI as compared with those without VFMI (53.8% vs. 21.4%, p = 0.008). There was no difference in length of stay between patients who did not have a diagnosis of VFMI and those found to have VFMI (41.0 days vs 45.3 days p = 0.73). CONCLUSIONS Universal LUS screening for patients following high-risk cardiac surgery may lead to earlier identification of postoperative VFMI and aspiration. Recognition of VFMI through this universal screening program could lead to earlier interventions and possibly improved swallowing outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1939-1944, 2024.
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Affiliation(s)
- Jennifer M Siu
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jessica Colyer
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Cassie Horner
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Aarti Bhat
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Lyubomyr Bohuta
- Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Titus Chan
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jennifer Fridgen
- Division of Physical Therapy, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Caitlin Yip
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Division of Otolaryngology-Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
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Masaki N, Tatewaki H, Kumae M, Ochiai T, Koizumi T, Ono T, Sonota K, Kimura M, Ozawa A, Sai S. Clinical Prognosis of Vocal Cord Paralysis After Cardiothoracic Surgery in Infants. Pediatr Cardiol 2024; 45:40-47. [PMID: 38070026 DOI: 10.1007/s00246-023-03341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024]
Abstract
We aimed to clarify the long-term outcomes and prognosis of vocal cord paralysis (VCP) after cardiothoracic surgery in infants as well as the usefulness of laryngeal ultrasound (LUS) as screening for VCP. Overall, 967 infants aged 1-year-old or younger who underwent cardiothoracic surgery between 2008 and 2022 were included in this study. We divided the patients into two groups based on the period on whether they underwent screening without or with LUS and compared the incidence of VCP between the groups. There were no differences in the patients' preoperative characteristics between the two periods, whereas the incidence of VCP was significantly higher in period 2 than in period 1 (11.0% vs. 3.2%, p < 0.0001). The incidence of VCP among the procedures, including aortic arch repair, was > 50% and significantly increased from period 1 to period 2. The sensitivity and specificity of LUS was 87% and 90%, respectively. Symptoms of VCP improved in 92% of patients. Repeated flexible laryngoscopy revealed that the residual rate of VCP was 68%, 52%, and 48% at 6, 12, and 24 months, respectively. In conclusion, symptoms of postoperative VCP improved in most cases; however, paralysis persisted in half of the patients. As a screening method, LUS is useful for evaluating postoperative VCP. A more accurate understanding of VCP is needed to improve postoperative outcomes.
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Affiliation(s)
- Naoki Masaki
- Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan
| | - Hideki Tatewaki
- Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan
| | - Masaru Kumae
- Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan
| | - Tomonori Ochiai
- Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan
| | - Taku Koizumi
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Tanomo Ono
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Kenji Sonota
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Masato Kimura
- Department of Cardiology, Miyagi Children's Hospital, Sendai, Japan
| | - Akira Ozawa
- Department of Cardiology, Miyagi Children's Hospital, Sendai, Japan
| | - Sadahiro Sai
- Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan.
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Monaghan N, McGhee H, Yuen E, Nguyen SA, Clemmens C. Effects of Body Positioning on Laryngeal Penetration and Aspiration in Children with Unilateral Vocal Cord Paralysis. Turk Arch Otorhinolaryngol 2023; 61:146-150. [PMID: 38784959 PMCID: PMC11110090 DOI: 10.4274/tao.2023.2023-8-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 05/25/2024] Open
Abstract
Objective To evaluate laryngeal penetration and aspiration in upright and side-lying positions in children with unilateral vocal cord paralysis (VCP) who underwent modified barium swallow study (MBSS). Methods A retrospective chart review (Pro00089051) of pediatric patients who were diagnosed with unilateral VCP and underwent MBSS was performed. Patients were identified using diagnostic code for VCP and based on diagnosis via flexible laryngoscopy. Once identified, MBSS notes were reviewed for data regarding laryngeal penetration, tracheal aspiration, and body position during the exam. Information was collected on the various consistencies of liquids used. The order of positioning was recorded in patients who had undergone both positions during the study. Data was analyzed using chi-square analysis. Results 811 patients had undergone MBSS between 2011 and 2014. Of these, 90 patients were isolated with unilateral VCP, and of those 90 patients, 23 (26%) had undergone MBSS in both side-lying and upright positions. When all 90 patients were evaluated, there was no difference in penetration or aspiration noted in the side-lying or upright position with thin liquids. Importantly, among the 23 (26%) patients that had been studied in both positions, there were no significant differences in penetration or aspiration relating to body position with any consistency. Conclusion Rates of penetration and aspiration were not associated with body position in patients who had undergone MBSS at our institution. However, due to an incomplete data set and a small sample size of those who underwent MBSS in both positions, these results should be further explored in prospective studies.
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Affiliation(s)
- Neil Monaghan
- Department of Otorhinolaryngology, Medical University of South Carolina, Charleston, United States of America
- College of Medicine, Medical University of South Carolina, Charleston, United States of America
| | - Heather McGhee
- Department of Speech Language Pathology, Medical University of South Carolina, Charleston, United States of America
| | - Erick Yuen
- Department of Otorhinolaryngology, Medical University of South Carolina, Charleston, United States of America
| | - Shaun A Nguyen
- Department of Otorhinolaryngology, Medical University of South Carolina, Charleston, United States of America
| | - Clarice Clemmens
- Department of Otorhinolaryngology, Medical University of South Carolina, Charleston, United States of America
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Kerstein JS, Klepper CM, Finnan EG, Mills KI. Nutrition for critically ill children with congenital heart disease. Nutr Clin Pract 2023; 38 Suppl 2:S158-S173. [PMID: 37721463 DOI: 10.1002/ncp.11046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter-based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision-making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.
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Affiliation(s)
- Jason S Kerstein
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
| | - Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Emily G Finnan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Kimberly I Mills
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
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Avasarala V, Aitharaju V, Encisco EM, Rymeski B, Ponsky TA, Huntington JT. Enteral access and reflux management in neonates with severe univentricular congenital heart disease: literature review and proposed algorithm. Eur J Pediatr 2023; 182:3375-3383. [PMID: 37191690 DOI: 10.1007/s00431-023-04992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
Neonates with severe congenital heart disease undergoing surgical repair may face various complications, including failure to thrive. Feeding tube placement and fundoplication are often performed to combat poor growth in neonates. With the variety of feeding tubes available and controversy surrounding when fundoplication is appropriate, there is no current protocol to determine which intervention is necessary for this patient population. We aim to provide an evidence-based feeding algorithm for this patient population. Initial searches for relevant publications yielded 696 publications; after review of these studies and inclusion of additional studies through external searches, a total of 38 studies were included for qualitative synthesis. Many of the studies utilized did not directly compare the different feeding modalities. Of the 38 studies included, five studies were randomized control trials, three studies were literature reviews, one study was an online survey, and the remaining twenty-nine studies were observational. There is no current evidence to suggest that this specific patient population should be treated differently regarding enteral feeding. We propose an algorithm to assist optimal feeding for neonates with congenital heart disease. Conclusion: Nutrition remains a vital component of the care of neonates with congenital heart disease; determining the optimal feeding strategy for these patients can be approached like other neonates.
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Affiliation(s)
- Vardhan Avasarala
- Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Varun Aitharaju
- Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ellen M Encisco
- Department of Pediatric Surgery, Akron Children's Hospital, 215 West Bowery Street, Level 6, Akron, OH, 44308, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Rymeski
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Todd A Ponsky
- Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Pediatric Surgery, Akron Children's Hospital, 215 West Bowery Street, Level 6, Akron, OH, 44308, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin T Huntington
- Department of Pediatric Surgery, Akron Children's Hospital, 215 West Bowery Street, Level 6, Akron, OH, 44308, USA.
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