Diaphragmatic paralysis among very low birth weight infants following ligation for patent ductus arteriosus

作者：Hsu Kai Hsiang; Chiang Ming Chou^*; Lien Reyin; Chu Jaw Ji; Chang Yu Sheng; Chu Shih Ming; Wong Kin Sun; Yang Peng Hong

来源：European Journal of Pediatrics, 2012, 171(11): 1639-1644.

DOI：10.1007/s00431-012-1787-4

• Bronchopulmonary dysplasia
• Diaphragmatic paralysis
• Patent ductus arteriosus
• Preterm infants
• Very low birth weight
• Plication

Management of diaphragmatic paralysis (DP) among newborn infants remains controversial, especially for very low birth weight (VLBW) infants following ligation for patent ductus arteriosus (PDA). This study aimed to characterize the impact of DP after PDA ligation among VLBW infants. Clinical characteristics of DP cases treated with either diaphragmatic plication or conservative methods were described as well. The medical records of VLBW infants who underwent PDA ligation in Chang Gung Memorial Hospital between January 2000 and December 2011 were retrospectively reviewed, and DP was suspected if postligation chest X-rays showed an elevation of the left diaphragm as confirmed by a chest ultrasonograph. For each DP case, three other infants that received PDA ligation with proximate birth dates and who were closely matched in terms of gestational age (+/- 1 week) and birth weight (+/- 10 %) were selected as the control group. A total of eight preterm infants were diagnosed as having DP and 24 infants were selected as the control group. The affected infants usually presented with respiratory distress and extubation failure. The study demonstrated that, among our patient population, DP was associated with a significantly longer duration of ventilator dependency (56.1 +/- 16.0 vs. 29.8 +/- 17.7 days, p = 0.001) and a higher incidence of severe bronchopulmonary dysplasia (87.5 vs. 23 %, p = 0.002). For selective infants with DP-related ventilatory failure after PDA ligation, surgical plication may facilitate extubation. Diaphragmatic paralysis should be evaluated carefully among VLBW infants receiving PDA ligation because of its adverse impact on ventilator dependency and correlation to a higher incidence of severe bronchopulmonary dysplasia.

• 出版日期2012-11
• 单位长春大学