Recorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort
| Autor: | Margo K. McKenna Benoit, Karen B. Zur, Stephen R. Chorney, Sri K. Chennupati, Lisa Elden, Sara B. DeMauro, Stacey Kleinman, Adva Buzi |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Cord Video Recording Diagnostic accuracy Article Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030225 pediatrics Humans Medicine Prospective Studies Vocal cord paralysis 030223 otorhinolaryngology Prospective cohort study Ductus Arteriosus Patent Ligation Observer Variation Laryngoscopy business.industry Incidence (epidemiology) Infant Newborn General Medicine medicine.disease Video assessment Otorhinolaryngology Infant Extremely Premature Female business Vocal Cord Paralysis |
| Zdroj: | Ann Otol Rhinol Laryngol |
| ISSN: | 1943-572X 0003-4894 |
| Popis: | Objective: Assessing vocal cord mobility by flexible nasolaryngoscopy (FNL) can be difficult in neonates. To date, prospective studies evaluating the incidence and diagnostic accuracy of vocal cord paralysis (VCP) after surgical patent ductus arteriosus (PDA) ligation are limited. It is unknown whether video FNL improves diagnosis in this population. This study compared video recordings with bedside evaluation for diagnosis of VCP and determined inter-rater reliability of the diagnosis of VCP in preterm infants after PDA ligation. Methods: Prospective cohort of preterm neonates undergoing bedside FNL within two weeks of extubation following PDA ligation. In a subset, FNL was recorded. Two pediatric otolaryngologists, blinded to the initial diagnosis, reviewed the FNL video recordings. Results: Eighty infants were enrolled and 37 with a recorded FNL were included in the cohort. Average gestational age at birth was 25.2 weeks (SD: 1.2) and postmenstrual age at FNL was 37.0 weeks (SD: 4.5), which was 9.5 days (SD: 14.7) after extubation following PDA repair. There were 6 diagnosed with left VCP (16.2%; 95% CI: 4.3-28.1%) at bedside, and 9 diagnosed by video review (24.3%; 95% CI: 10.5-38.1%) ( P = .56). Videos confirmed all 6 VCP diagnosed initially, but also identified 3 additional cases. Though imperfect, reviewing FNL by video showed substantial reliability (kappa = .75), with 91.9% agreement. Conclusion: Video recorded FNL most often confirms a bedside diagnosis of VCP, but may also identify discrepancies. Physicians should consider the limitations of diagnosis especially when infants persist with symptoms such as weak voice or signs of postoperative aspiration. Level of Evidence 2b |
| Databáze: | OpenAIRE |
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