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Vocal cord dysfunction and feeding difficulties after pediatric cardiovascular surgery.

Sachdeva R, Hussain E, Moss MM, Schmitz ML, Ray RM, Imamura M, Jaquiss RD

Department of Pediatrics, Division of Pediatric Cardiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. sachdevaritu@uams.edu

OBJECTIVE: To evaluate the impact of vocal cord dysfunction on feeding in children after cardiovascular surgery. STUDY DESIGN: Of the 2255 children who had cardiovascular surgery between January 2000 to January 2006, 38 (1.7%) had postoperative vocal cord dysfunction confirmed at laryngoscopy. The following data were obtained retrospectively: type of surgery, laryngoscopic examination results, swallowing studies, upper gastrointestinal (UGI) studies, and feeding route: oral, nasogastric tube (NG), and gastrostomy. RESULTS: Surgeries included aortic arch reconstruction (n = 20), patent ductus arteriosus ligation (n = 8), arterial switch (n = 3), cervical cannulation for extracorporeal membrane oxygenation (n = 2), and others (n = 5). A swallowing study confirmed dysfunction in 27 of 29 patients. Gastrostomy was placed in 18/38 patients. At discharge, 18 patients were fed by gastrostomy, 13 orally, 3 by NG, and 4 by combination oral/NG. At a median follow-up of 12 months, 20 were fed orally, 1 by NG, 7 by gastrostomy, 7 by combination gastrostomy/orally, 1 was lost to follow-up, 2 died. CONCLUSION: Vocal cord dysfunction after pediatric cardiovascular surgery is associated with significant feeding problems and may require prolonged gastrostomy feeding. These findings support aggressive surveillance for vocal cord dysfunction, especially in patients undergoing aortic arch surgery.

Published 27 August 2007 in J Pediatr, 151(3): 312-5, 315.e1-2.
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