Abstract 14070: Causes and Consequences: Pre- and Postoperative Laryngopharyngeal Dysfunction in Neonates Undergoing Heart Surgery
Background: Laryngopharyngeal dysfunction plays a significant role in the postoperative care of neonatal patients undergoing interventions on the aortic arch. Previous studies have focused primarily on postoperative evaluation and patients with vocal cord paresis, ignoring preoperative dysfunction in this population with complex medical disease. Here we report a prospective study of pre- and post-operative laryngopharyngeal function and its importance in perioperative management.
Methods: We performed preoperative assessment by direct laryngoscopy (DL) and oral feeding evaluation (OFE) on 102 patients undergoing 112 arch interventions 2006-2011. Postoperative assessment included DL, OFE, and modified barium swallow (mBS). Primary outcome was the ability to take full oral feeds at discharge (fullPO). Secondary outcomes included vocal cord paresis (VCP) and pharyngeal dysfunction (PhD)
Results: Surgeries included stage I Norwood (n=34), hybrid stage I n=15), combined stage I/stage II after hybrid (n=3), aortic arch reconstruction (n=37), and repair of coarctation (n=24). Only 30.1% of patients were tolerating full PO feeds at discharge. Abnormal preoperative OFE was predictive of an inability to tolerate full PO (p<0.0001, positive predictive value 100%). Procedural variables predicted the inability to tolerate full PO: hybrid procedure (odds ratio 21.9, 95%CI 1.3-373.9), aortic coarctation (0.3,0.1-0.8). Other preoperative factors, including age, weight, a history of syndromic or chromosomal abnormalities were not predictive. Postop VCP occurred in 39.1% of patients; patients with VCP were unlikely to tolerate PO feeds (OR 3.2, 95%CI 1.7-12.5), but only 56.5% of patients without VCP tolerated PO at discharge. 10/55 patients with aspiration on mBS had “silent” aspiration without symptoms. Longer duration of mechanical ventilation was associated with the inability to take full PO (64±53hrs vs. 203±330hrs, p = 0.0001).
Conclusion: LPD affects a large proportion of infants undergoing aortic arch reconstruction; while most have symptoms, many do not and routine evaluation may be indicated. VCP is important, but other factors including both preoperative feeding intolerance and posteropative management also play a signficant role.
- © 2011 by American Heart Association, Inc.