RESUMO
OBJECTIVES/HYPOTHESIS: To determine the incidence of left vocal fold paralysis (LVFP) in premature infants who undergo patent ductus arteriosus (PDA) ligation. STUDY DESIGN: Prospective cohort. METHODS: The study was carried out in the newborn intensive care unit (NICU) of a tertiary academic medical center. Eighty-six premature newborns who underwent ligation of a PDA were examined postextubation with fiberoptic laryngoscopy to assess vocal fold mobility, regardless of laryngeal symptom status. RESULTS: Fourteen infants (16%) had LVFP. All were <28 weeks postmenstrual age (PMA) at birth and <1,250 g at PDA ligation, and were significantly less mature and smaller than infants without LVFP. Infants <28 weeks PMA at birth and <1,250 g at ligation had an incidence of LVFP of 23% and 24%, respectively. Fourteen percent of the infants with LVFP did not have laryngeal symptoms and would have been missed had these been the sole criteria for assessing vocal fold mobility. CONCLUSIONS: The incidence of LVFP after PDA ligation in the NICU is high, and some cases may be missed if laryngoscopy is performed only when laryngeal symptoms are present. Infants <28 weeks PMA at birth and <1,250 g at ligation are at especially high risk. Vocal fold mobility should be documented by laryngoscopy on all high-risk infants undergoing a PDA ligation in the NICU regardless of laryngeal symptom status, and on all infants with relevant symptoms. The high incidence of this complication warrants greater efforts to prospectively assess vocal fold mobility status in high-risk infants who undergo PDA ligation.
Assuntos
Recém-Nascido Prematuro , Complicações Intraoperatórias/etiologia , Traumatismos do Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologia , Estudos de Coortes , Tomada de Decisões , Permeabilidade do Canal Arterial/cirurgia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Ligadura/efeitos adversos , Ligadura/métodos , Modelos Logísticos , Masculino , Triagem Neonatal/métodos , Probabilidade , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Paralisia das Pregas Vocais/diagnósticoRESUMO
Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.