To determine the natural history of patient with bilateral vocal fold immobility (BVFI), and to identify the factors or predictors associated with the tracheostomy and duration of cannulation for those who require tracheostomy.A retrospective review was carried out at a single tertiary referral center over a 23-year period of infants less than 1 year old who presented with BVFI. All information related to sex, etiology, gestational age at birth, vocal fold (VF) position at diagnosis, presence of concomitant airway disease, age at attainment of VF movement, age at decannulation, and current tracheostomy status were recorded to perform descriptive and comparative analyses.Forty-one patients were enrolled, and the tracheostomy rate was 80.5% (33/41). Those with a median VF position had a higher rate of tracheostomy in comparison with those with a paramedian VF position (P = .003). Among patients who underwent tracheostomy, 77.4% (24/31) were eventually decannulated. The median duration of cannulation was 4.4 years (range: 0.8 − 10.7 years). Those who were found to have attainment of VF movement at less than 1-year-old had a shorter duration of cannulation than others (mean: 1.9 years vs 5.2 years, P < .001). The mortality rate of those patients who received tracheostomy was 9.7% (3/31).Although a high tracheostomy rate was found in BVFI patients, most of them underwent decannulation. The earlier attainment of VF movement is achieved, the shorter duration of cannulation is required. This information is important for physicians while following up BVFI patients who have undergone tracheostomy.

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

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