Vocal fold paralysis in preterm infants: prevalence and analysis of risk factors

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. 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. 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). Given the prevalence of VFP and its associated morbidity, efforts to decrease PDA ligation and invasive ventilation in preterm infants are warranted.