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Zur KB, Douglas J, Carroll LM. Intubation-Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients. Laryngoscope 2021; 131:2550-2557. [PMID: 33956345 DOI: 10.1002/lary.29592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. STUDY DESIGN Retrospective Study. METHODS Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. RESULTS Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0-3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS-2 and BDSS-3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS-1 (mild) or BDSS-2. History of multiple and prolonged intubations were seen more frequently in BDSS-2 or BDSS-3. Post-op pVHI reduced an average of 15 points for BDSS-0 to BDSS-2, but only 3 points for BDSS-3. Post-op pVHI matched normal values for preintervention dysphonic children. CONCLUSIONS The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher-grade BDs, whereas low GA is more likely to be associated with BDSS-1 to BDSS-2. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Karen B Zur
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology: Head & Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer Douglas
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Otolaryngology: Head & Neck Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Linda M Carroll
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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2
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Engan M, Engeset MS, Sandvik L, Gamlemshaug OCO, Engesæter IØ, Øymar K, Vollsæter M, Røksund OD, Hufthammer KO, Halvorsen T, Clemm HH. Left Vocal Cord Paralysis, Lung Function and Exercise Capacity in Young Adults Born Extremely Preterm With a History of Neonatal Patent Ductus Arteriosus Surgery-A National Cohort Study. Front Pediatr 2021; 9:780045. [PMID: 35047462 PMCID: PMC8761768 DOI: 10.3389/fped.2021.780045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses. Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term. Methods: Adults born EP (<28 weeks' gestation or birth weight <1,000 g) in Norway during 1999-2000 who underwent neonatal PDA surgery and controls born EP and at term were invited to complete questionnaires mapping voice-and respiratory symptoms, and to perform spirometry and maximal treadmill exercise testing. In the PDA-surgery group, exercise tests were performed with a laryngoscope positioned to evaluate laryngeal function. Results: Thirty out of 48 (63%) eligible PDA-surgery subjects were examined at mean (standard deviation) age 19.4 (0.8) years, sixteen (53%) had LVCP. LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, not with lung function or peak oxygen consumption (VO2peak). In the PDA-surgery group, forced expiratory volume in 1 second z-score (z-FEV1) was reduced compared to EP-born controls (n = 30) and term-born controls (n = 36); mean (95% confidence interval) z-FEV1 was -1.8 (-2.3, -1.2), -0.7 (-1.1, -0.3) and -0.3 (-0.5, -0.0), respectively. For VO2peak, corresponding figures were 37.5 (34.9, 40.2), 38.1 (35.1, 41.1), and 43.6 (41.0, 46.5) ml/kg/min, respectively. Conclusions: LVCP was common in EP-born young adults who had undergone neonatal PDA surgery. Within the PDA-surgery group, LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, however we did not find an association with lung function or exercise capacity. Overall, the PDA-surgery group had reduced lung function compared to EP-born and term-born controls, whereas exercise capacity was similarly reduced for both the PDA-surgery and EP-born control groups when compared to term-born controls.
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Affiliation(s)
- Mette Engan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Merete S Engeset
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Lorentz Sandvik
- Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ole C O Gamlemshaug
- Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Ø Engesæter
- Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola D Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Otolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege H Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Engeseth MS, Engan M, Clemm H, Vollsæter M, Nilsen RM, Markestad T, Halvorsen T, Røksund OD. Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus. Front Pediatr 2020; 8:150. [PMID: 32322565 PMCID: PMC7156623 DOI: 10.3389/fped.2020.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA). Study design: Prospective follow-up of all children born in Norway during 1999-2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires. Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes. Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.
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Affiliation(s)
- Merete S Engeseth
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mette Engan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola D Røksund
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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Reynolds MV, Madden SK, Ryan AB. The influence of premature birth on laryngeal development for phonation. Int J Pediatr Otorhinolaryngol 2019; 122:165-169. [PMID: 31035174 DOI: 10.1016/j.ijporl.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dysphonia is a known consequence of premature birth, and is usually associated with endotracheal intubation in the neonatal period or surgical ligation of persistent patent ductus arteriosus. Recently, cases of dysphonia, in the absence of these causative factors, have been reported. OBJECTIVES This review seeks to identify literature pertaining to those aspects of laryngeal development that may potentially be disrupted by premature birth. The purpose of the review is to determine whether there is any possible anatomical or physiological explanation for dysphonia to arose solely from premature birth. METHODS This scoping review was conducted in accordance with the guidelines prescribed by Arskey and O'Malley (2005). Fifteen relevant papers were identified. Results were categorized into age-related categories, to identify changes in the developmental trajectory. Based on the results of the literature search, a further category of unphonated larynges was added. RESULTS Potential differences in the laryngeal framework (e.g., the development of the cricoid cartilage and the shape of the glottis) and vocal fold histology, depending on gestational age and post-natal phonation were identified. Much literature focused on the macula flavae, however, the layers of the lamina propria were also discussed. DISCUSSION It is unclear whether the process of differentiation of the layers of the lamina propria, which commences in the second to third months of life in term-born infants, is disrupted by prematurity. Further, development of the macula flavae continues until at least 28 weeks' gestation. Preterm children may not phonate immediately after birth, which may also affect laryngeal development.
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Affiliation(s)
| | - Shayla K Madden
- State University New York College at Plattsburgh, United States
| | - Amy B Ryan
- State University New York College at Plattsburgh, United States
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Hseu A, Ayele N, Kawai K, Woodnorth G, Nuss R. Voice Abnormalities and Laryngeal Pathology in Preterm Children. Ann Otol Rhinol Laryngol 2018; 127:508-513. [DOI: 10.1177/0003489418776987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: The prevalence of voice abnormalities in children born prematurely has been reported to be as high as 58%. Few studies have examined these abnormalities with laryngoscopic or videostroboscopic findings and characterized their laryngeal pathologies. Objective: To review voice abnormalities in patients with a history of prematurity and characterize the etiology of their voice problems. A secondary objective is to see if there is a correlation between the findings and the patient’s intubation and surgical history. Methods: A retrospective chart review was conducted of all preterm patients seen in voice clinic at a tertiary pediatric hospital. Demographic data, diagnoses, and office laryngoscopies were reviewed as well as any speech therapy evaluations and/or medical and surgical treatments. Results: Fifty-seven patients were included. Mean age at presentation was 5.1 (±4.3) years. Mean gestational age was 27.8 (±3.7) weeks. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) perceptual evaluations included a mean overall dysphonia severity of 46.6 (±24.2). Patients who had undergone prolonged intubation (⩾28 days) in the NICU or had prolonged NICU stays (>12 weeks) had significantly higher overall dysphonia severity scores. Thirty-three patients with vocal fold hypo- or immobility had significantly greater voice deviance in breathiness, loudness, and overall severity compared to those without vocal fold immobility. Of all patients, 35% were recommended surgical intervention and 49% voice therapy. Conclusion: Intubation greater than 28 days and prolonged NICU stays are associated with more severe dysphonia in premature patients. There should be a low threshold for clinical evaluation of dysphonia in this unique patient population.
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Affiliation(s)
- Anne Hseu
- Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts, USA
| | - Nohamin Ayele
- Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts, USA
| | - Geralyn Woodnorth
- Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts, USA
| | - Roger Nuss
- Boston Children’s Hospital, Department of Otolaryngology and Communication Enhancement, Boston, Massachusetts, USA
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6
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Jabbour J, Robey T. Resolution of vocal fold immobility in preterm infants. Int J Pediatr Otorhinolaryngol 2017; 103:83-86. [PMID: 29224772 DOI: 10.1016/j.ijporl.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/22/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vocal fold immobility (VFI) is an important sequela of preterm birth due to patent ductus arteriosus (PDA) ligation and invasive ventilation. A minority of these patients experience VFI resolution. The purpose of this study is to determine factors associated with VFI resolution in preterm infants. METHODS This is a case control study of preterm (<37 weeks gestation) infants admitted to a metropolitan Level IV neonatal intensive care unit from 2006 to 2012. All patients diagnosed with VFI by flexible nasolaryngoscopy were divided into 2 cohorts: those with and without laryngoscopic resolution of VFI during follow-up. Univariate and multivariate analyses were performed to determine factors associated with VFI resolution. RESULTS Of 71 patients with VFI and adequate follow-up, 17 (23.9%) experienced resolution. Median (range) follow-up was 25.7 (0.4-91.3) months and time to resolution 4.4 (0.4-38.8) months. Compared to the ongoing-VFI cohort, those who experienced resolution had higher median gestational age (31 vs 25 weeks, p = 0.006) and birth weight (1550 vs 765 g, p = 0.02), and lower likelihood of undergoing PDA ligation (47.1% vs 77.8%, p = 0.02). On multivariate analysis, history of PDA ligation remained independently associated with a lower likelihood of VFI resolution (p = 0.02, OR 0.2, 95% CI 0.1-0.8). Among PDA ligation patients, birth weight >1000 g was more common in the resolution cohort compared to the ongoing-VFI cohort (62.5% vs 24.4%, p = 0.047). CONCLUSION While lower birth weight and gestational age are known risk factors for VFI following PDA ligation, in this study, these factors were also associated with a decreased likelihood of VFI resolution. Furthermore, PDA ligation appears to be a risk for both the development and persistence of VFI. This evidence should inform prognosis and intervention decisions for preterm infants with VFI.
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Affiliation(s)
- Jad Jabbour
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital/Harvard Medical School, 300 Longwood Ave, BCH 3129, Boston, MA 02115, USA.
| | - Thomas Robey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA; Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, 8915 W Connell Ct, Milwaukee, WI 53226, USA.
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7
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Jabbour J, Uhing M, Robey T. Vocal fold paralysis in preterm infants: prevalence and analysis of risk factors. J Perinatol 2017; 37:585-590. [PMID: 28102857 DOI: 10.1038/jp.2016.263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/04/2016] [Accepted: 12/14/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To calculate the prevalence of vocal fold paralysis (VFP) in preterm (<37 weeks of gestation) infants at a single neonatal intensive care unit (NICU) and identify risk factors for the development of VFP. STUDY DESIGN This is a case control study of all surviving preterm infants admitted to the NICU at Children's Hospital of Wisconsin from 2006 to 2012, comparing those with and without VFP. Multivariate analysis was performed to identify significant risk factors for VFP. RESULTS Of the 2083 patients included, 73 (3.5%) had VFP, including 18% of those at <26 weeks of gestation. On multivariate analyses, VFP was associated with patent ductus arteriosus (PDA) ligation (P<0.001, odds ratio (OR) 15.9, 95% confidence interval (CI) 8.9 to 28.1), history of invasive ventilation (P=0.008, OR 4.5, 95% CI 1.5 to 13.6) and black vs non-black race (P=0.001, OR 2.5, 95% CI 1.5 to 4.3). CONCLUSION Given the prevalence of VFP and its associated morbidity, efforts to decrease PDA ligation and invasive ventilation in preterm infants are warranted.
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Affiliation(s)
- J Jabbour
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Uhing
- Division of Neonatology, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Neonatology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - T Robey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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8
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. A Randomized, Controlled Trial of Behavioral Voice Therapy for Dysphonia Related to Prematurity of Birth. J Voice 2017; 31:247.e9-247.e17. [DOI: 10.1016/j.jvoice.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Voice problems in school-aged children following very preterm birth. Arch Dis Child 2016; 101:556-560. [PMID: 26906071 DOI: 10.1136/archdischild-2015-309441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/02/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Very preterm children may be at risk of voice abnormalities (dysphonia). Risk factors previously identified in extremely preterm children include female gender, multiple intubations, complicated intubation and very low birth weight. This study sought to identify the prevalence of dysphonia in very preterm children, at school age. METHODS Children born between 23 and 32 weeks' gestation were included in this prospective observational study. Participants were randomly selected from a sample stratified by gestational age and number of intubations, and were aged between 5 and 12 years at the time of assessment. Clinical voice assessments were conducted by a speech pathologist, and a diagnosis of dysphonia was made based on the presence and severity of disturbance to the voice. Retrospective chart review identified medical and demographic characteristics. RESULTS 178 participants were assessed. The prevalence of dysphonia in this cohort was 61%. 31% presenting with significant dysphonia, that is, voice disturbance of greater than mild in severity. Female gender (p=0.009), gestational age (p=0.031) and duration of intubation (p=0.021) were significantly associated with dysphonia although some preterm children with dysphonia were never intubated. CONCLUSIONS Significant voice abnormalities were observed in children born at up to 32 weeks' gestation, with intubation a major contributing factor. TRIAL REGISTRATION NUMBER ACTRN12613001015730.
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Affiliation(s)
- Victoria Reynolds
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Suzanne Meldrum
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,School of Psychology and Social Science, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Shyan Vijayasekaran
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Noel French
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.,Health Department of Western Australia, State Child Development Centre, Perth, Western Australia, Australia
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Zur KB, Carroll LM. Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. Laryngoscope 2015; 125 Suppl 11:S1-15. [DOI: 10.1002/lary.25538] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Karen B. Zur
- Department of Pediatric Otolaryngology; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
- Department of Otolaryngology-Head & Neck Surgery; Perelman School of Medicine of The University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Linda M. Carroll
- Department of Pediatric Otolaryngology; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Dysphonia in extremely preterm children: A longitudinal observation. LOGOP PHONIATR VOCO 2015; 41:154-8. [DOI: 10.3109/14015439.2015.1054307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Victoria Reynolds
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
| | - Suzanne Meldrum
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- Edith Cowan University, School of Psychology and Speech Pathology, Joondalup, Australia
| | - Karen Simmer
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- King Edward Memorial Hospital, Department of Neonatal Paediatrics, Subiaco, Australia
| | - Shyan Vijayasekaran
- University of Western Australia, School of Paediatrics and Child Health, Crawley, Australia
- Princess Margaret Hospital, Department of Paediatric Otorhinolaryngology and Head and Neck Surgery, Subiaco, Australia
- University of Western Australia, School of Surgery, Crawley, Australia
| | - Noel French
- King Edward Memorial Hospital, Department of Neonatal Paediatrics, Subiaco, Australia
- State Child Development Centre, West Perth, Australia
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Pediatric quality of life in children with otolaryngologic disease: what inventories are available and what is still needed? Curr Opin Otolaryngol Head Neck Surg 2015; 22:506-20. [PMID: 25268301 DOI: 10.1097/moo.0000000000000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Quality of life (QOL) is an important patient-oriented outcome in common disorders, particularly when one management strategy is not clearly superior to an alternative. This article reviews the recently published literature that evaluated QOL in children with common pediatric otolaryngologic problems. RECENT FINDINGS Among the 41 reviewed articles that used QOL as an outcome, 14 disease-specific QOL surveys and 12 generic QOL questionnaires were used. QOL instruments that had been validated in adults were frequently used in children without validation in pediatric populations. For children, parent-reported outcomes of caregiver concerns are often used as proxy measures of QOL for the child, and only a few QOL instruments asked the child to rate their own perception of their QOL. Several studies used nonvalidated QOL surveys as outcomes. SUMMARY QOL is being evaluated in an increasing number of pediatric otolaryngologic disorders. Although there are numerous surveys to measure generic pediatric QOL, validated disease-specific surveys for children are less common, especially those that utilize child self-report. The lack of disease-specific pediatric surveys for otolaryngologic disorders hampers the ability to document change or differences in patient-oriented outcomes with interventions.
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13
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Laryngeal pathology at school age following very preterm birth. Int J Pediatr Otorhinolaryngol 2015; 79:398-404. [PMID: 25613933 DOI: 10.1016/j.ijporl.2014.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/23/2014] [Accepted: 12/25/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intubation injury resulting in laryngeal pathology is recognised as a possible complication of preterm birth, yet few published studies have examined such pathology and its relation to voice outcomes. This study reports on the results of prospective laryngeal function examinations of a cohort of very preterm children, all of whom presented with significant dysphonia at school age. MATERIALS AND METHODS The laryngeal pathology of 20 very preterm children, born between 23 and 29 weeks gestation, was examined under halogen and stroboscopic conditions. Laryngeal structure and function were assessed using a rigid laryngoscope or a flexible nasendoscope. The approach was selected based on the age and/or likely compliance of the child. RESULTS Nineteen children were found to have structural laryngeal pathology. Fourteen children presented with a chink to the posterior glottis and all demonstrated at least a mild degree of supraglottic hyperfunction. Other common findings were arytenoid prolapse and vocal fold immobility. More isolated findings included posterior scar band, vocal fold atrophy, arytenoid oedema and growth on the vocal folds. One child who presented with structural laryngeal pathology was never intubated. DISCUSSION Supraglottic hyperfunction was common to all participants, regardless of the nature and extent of underlying structural laryngeal pathology. Posterior glottic chink was the most common pattern of incomplete vocal fold closure. These data support the hypothesis that very preterm children adopt supraglottic tightening to compensate for underlying laryngeal pathology. The mechanism underlying laryngeal damage in the child who was not intubated is unclear. CONCLUSIONS Voice quality of very preterm children is affected by both laryngeal structure and function. A trial of behavioural voice treatment is recommended to evaluate any therapeutic response in this population.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | - Suzanne Meldrum
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; School of Psychology and Speech Pathology, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, WA, Australia
| | - Karen Simmer
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Shyan Vijayasekaran
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia; Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Noel French
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia; State Child Development Centre, Health Department of Western Australia, Perth, WA, Australia
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14
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Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, Campbell C, Chandler S, Cheong J, Darlow B, Davis PG, DePaoli T, French N, McPhee A, Morris S, O’Callaghan M, Rieger I, Roberts G, Spittle AJ, Wolke D, Woodward LJ. Long term follow up of high risk children: who, why and how? BMC Pediatr 2014; 14:279. [PMID: 25399544 PMCID: PMC4289257 DOI: 10.1186/1471-2431-14-279] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted. DISCUSSION This paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps. SUMMARY A substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.
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Affiliation(s)
- Lex W Doyle
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Peter J Anderson
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Malcolm Battin
- />National Women’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer R Bowen
- />Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales Australia
| | - Nisha Brown
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Newborn Services, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Callanan
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Campbell
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Samantha Chandler
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Jeanie Cheong
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Brian Darlow
- />Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Peter G Davis
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Tony DePaoli
- />Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania Australia
| | - Noel French
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Andy McPhee
- />Neonatal Services, Women’s and Children’s Health Network, North Adelaide, South Australia Australia
| | - Shusannah Morris
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Michael O’Callaghan
- />Paediatrics and Child Health, Mater Clinical School, University of Queensland, Brisbane, Queensland Australia
| | - Ingrid Rieger
- />Department of Neonatal Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales Australia
- />Faculty of Medicine, University of Sydney, Sydney, New South Wales Australia
| | - Gehan Roberts
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Community Child Health, The Royal Children’s Hospital, Parkville, Victoria Australia
| | - Alicia J Spittle
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Physiotherapy, The University of Melbourne, Parkville, Victoria Australia
| | - Dieter Wolke
- />Department of Psychology, The University of Warwick, Coventry, UK
| | - Lianne J Woodward
- />Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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15
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Intubation-Related Dysphonia Following Extreme Preterm Birth: Case Studies in Behavioural Voice Intervention. ACTA ACUST UNITED AC 2014. [DOI: 10.1044/vvd24.3.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many more children than ever before survive and thrive following preterm birth (Saigal & Doyle, 2008). To date, research has focussed on medical, developmental, neurological, and behavioral outcomes. As the number of surviving children increases and survivors reach school age and beyond, it has become apparent that many children experience difficulties with voice production (French et al., 2013). Following preterm birth, endotracheal intubation may be necessary to deliver surfactant or relieve respiratory distress during the neonatal period (Ho, Subramaniam, Henderson-Smart, & Davis, 2002). Intubation injury to the larynx and resultant dysphonia are well described in the literature (Bray, Cavalli, Eze, Mills, & Hartley, 2010). This article presents a brief review of the literature relevant to intubation-related injury following preterm birth and 2 case studies of voice outcomes following a trial of behavioral voice therapy in extremely preterm children who were intubated.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
- Speech Pathology Department, Princess Margaret Hospital for Children
Subiaco, Western Australia
| | - Suzanne Meldrum
- Speech Pathology Department, Princess Margaret Hospital for Children
Subiaco, Western Australia
- School of Psychology and Social Science, Edith Cowan University
Perth, Western Australia
| | - Karen Simmer
- School of Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children
Subiaco, Western Australia
- Centre for Neonatal Research and Education, University of Western Australia
Perth, Western Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology and Head and Neck Surgery, Princess Margaret Hospital for Children
Subiaco, Western Australia
- Schools of Surgery and Paediatrics and Child Health, University of Western Australia
Perth, Western Australia
| | - Noel French
- Department of Neonatal Paediatrics, King Edward Memorial Hospital and Princess Margaret Hospital for Children
Subiaco, Western Australia
- Centre for Neonatal Research and Education, University of Western Australia
Perth, Western Australia
- State Child Development Centre, Health Department of Western Australia
Perth, Western Australia
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16
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Walz PC, Hubbell MP, Elmaraghy CA. Voice related quality of life in pediatric patients with a history of prematurity. Int J Pediatr Otorhinolaryngol 2014; 78:1010-4. [PMID: 24768275 PMCID: PMC4166401 DOI: 10.1016/j.ijporl.2014.03.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/16/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions. METHODS Cohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection. RESULTS Sixty-nine participants were included. Mean age at follow-up was 28 (3-197) months. Mean gestational age was 29 (23-37) weeks. Mean intubation duration was 3 (0-22) weeks and median number of intubations was 1 (range 0-5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2±18.1 (25-100) and pVOS with a mean of 11.4±2.2 (0-13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p<0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p=0.0028, OR=6.4, 95% CI=1.9-21.6). CONCLUSIONS The data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population.
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Affiliation(s)
- Patrick C Walz
- Ann and Robert H. Lurie Children's Hospital, McGaw Medical Center, Northwestern University, Chicago, IL, United States; Nationwide Children's Hospital, Columbus, OH, United States; Wexner Medical Center at the Ohio State University, Columbus, OH, United States.
| | | | - Charles A Elmaraghy
- Nationwide Children’s Hospital, Columbus, OH,Wexner Medical Center at the Ohio State University, Columbus, OH
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17
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Dysphonia in preterm children: Assessing incidence and response to treatment. Contemp Clin Trials 2014; 37:170-5. [DOI: 10.1016/j.cct.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/19/2013] [Accepted: 12/22/2013] [Indexed: 11/21/2022]
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18
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Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N. Dysphonia in very preterm children: a review of the evidence. Neonatology 2014; 106:69-73. [PMID: 24819149 DOI: 10.1159/000360841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/25/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intubation is a known risk factor for dysphonia yet is essential in the perinatal care of many very preterm infants. Children born preterm, who are frequently resuscitated with endotracheal intubation, may be at risk of dysphonia at school age and beyond. OBJECTIVES To identify and describe the evidence pertaining to long-term voice outcomes and risk factors for developing dysphonia in preterm children. RESULTS In addition to case studies and series, three larger-scale studies have reported on dysphonia and voice outcomes in preterm children. Studies reporting treatment outcomes were not available. Factors associated with poor voice outcomes included female gender, birth weight <1,000 g, birth at <27 weeks' gestation, surgical closure of patent ductus arteriosus, emergency versus elective intubations and multiple intubations. Adverse voice outcomes were associated with laryngeal pathology and compensatory supraglottic compression. CONCLUSIONS Dysphonia is a newly reported, long-term complication of preterm birth, yet the number of relevant studies remains limited. Further research is required to confirm the risk factors for developing dysphonia, which will inform future voice treatment studies.
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Affiliation(s)
- Victoria Reynolds
- School of Paediatrics and Child Health, University of Western Australia, Perth, W.A., Australia
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19
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Fischer HS, Bührer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 2013; 132:e1351-60. [PMID: 24144716 DOI: 10.1542/peds.2013-1880] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Mechanical ventilation via an endotracheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants <30 weeks' gestational age (GA). METHODS In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants <30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6. RESULTS We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage. CONCLUSIONS Strategies aimed at avoiding eMV in infants <30 weeks' GA have a small but significant beneficial impact on preventing BPD.
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Affiliation(s)
- Hendrik S Fischer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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