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 Vol. 10 No. 10, October 2009
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NeoReviews Vol.10 No.10 2009 e494
© 2009 American Academy of Pediatrics

Neonatal Vocal Cord Paralysis

Jennifer R. Benjamin, MD*
Ronald N. Goldberg, MD{dagger}
William F. Malcolm, MD{ddagger}

* Division of Neonatal-Perinatal Medicine, Jean and George Brumley Jr. Neonatal Perinatal Research Institute, Department of Pediatrics, Duke University Medical Center, Durham, NC
{dagger} Chief, Division of Neonatal-Perinatal Medicine, Jean and George Brumley Jr. Neonatal Perinatal Research Institute, Department of Pediatrics, Duke University Medical Center, Durham, NC
{ddagger} Assistant Professor, Division of Neonatal-Perinatal Medicine, Jean and George Brumley Jr. Neonatal Perinatal Research Institute, Department of Pediatrics, Duke University Medical Center, Durham, NC

Neonatal vocal cord paralysis (VCP) remains an important cause of acute and chronic respiratory compromise in infants. Despite a normal cry, infants who have bilateral VCP may present with marked respiratory distress, and emergency tracheostomy is a lifesaving procedure in the most severe cases. Unilateral VCP usually causes more pronounced abnormalities of the infant's voice, but respiratory symptoms are typically mild. VCP most commonly results from iatrogenic causes due to injury to the left recurrent laryngeal nerve during cardiac surgery. VCP also can result from congenital or neurologic disorders. Vocal cord dysfunction usually improves over time but may take years to resolve. Infants who have VCP are at risk for aspiration, prolonged duration of mechanical ventilation, reactive airway disease, and persistent feeding problems. Serial examination of vocal cord function at regular intervals using flexible fiberoptic endoscopy or direct laryngoscopy is essential to monitor airway patency and document improvement or resolution of paralysis over time. Affected infants also must be followed closely to determine the need for future medical or surgical intervention.

Abbreviations: BPD: bronchopulmonary dysplasia • ELBW: extremely low birthweight • PDA: patent ductus arteriosus • RAD: reactive airway disease • VCP: vocal cord paralysis


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