Voice Abnormalities at School Age in Children Born Extremely Preterm

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Isolated case reports of abnormal voice after extremely preterm birth are well described; however, there are no systematic studies of long-term voice outcomes in children born preterm.WHAT THIS STUDY ADDS: Significant voice abnormalities were found in more than half of tested children born before 25 weeks' gestation. Multivariable analyses showed that the number of intubations, not the duration of intubation, and female gender were strongly associated with this adverse outcome. abstract BACKGROUND AND OBJECTIVES: Voice abnormality is a frequent finding in school age children born at ,25 weeks' gestation in Western Australia. The objective of this study was to determine the frequency of voice abnormality, voice-related quality of life, and demographic and intubation factors in this population. METHODS:Survivors ,25 weeks' gestational age in Western Australia born from 1996 to 2004 were included. Voice assessments (auditory perceptual assessment scale and Pediatric Voice Handicap Index) were carried out by speech pathologists. Intubation history was obtained by retrospective chart review. RESULTS:Of 251 NICU admissions, 154 (61%) survived. Exclusions were based on severe disability (11) or distant residence (13). Of 70 assessed, 67 completed assessments, 4 (6%) were in the normal range and 39 (58%) showed moderate-severe hoarseness. Simultaneous modeling of demographic and intubation characteristics showed an increased odds of moderate-severe voice disorder for children who had more than 5 intubations (odds ratio 6.96, 95% confidence interval 2.07-23.40, P = .002) and for girls relative to boys (odds ratio 3.46, 95% confidence interval 1.12-10.62, P = .030). Tube size and duration of intubation were not significant in the multivariable model. Median scores of parent-reported voice quality of life on the Pediatric Voice Handicap Index were markedly different for preterm (22) and term (3) groups, P , .001. CONCLUSIONS:Voice disorders in this population were much more frequent than expected. Further studies are required to assess voice across a broader range of gestational ages, and to investigate voiceprotective strategies in infants requiring multiple episodes of intubation. Pediatrics 2013;131:e733-e739 AUTHORS:

Avoiding Endotracheal Ventilation to Prevent Bronchopulmonary Dysplasia: A Meta-analysis

“…Firstly, noninvasive respiratory support may prevent direct complications of a difficult intubation, such as vocal cord dysfunction or subglottic stenosis, which may lead to prolonged ventilation and ventilator-induced lung injury. 50,51 Secondly, the absence of an endotracheal tube may avoid reflex-induced apnea occurring in response to mechanical stimulation of the laryngeal mucosa. 52 Thirdly, noninvasive respiratory support preserves normal laryngeal function, allows normal mucociliary clearance of lung secretions, and may prevent secondary lung damage by reducing the incidence of ventilatorassociated pneumonia.…”

Laryngeal pathology at school age following very preterm birth

“…Thirteen participants were female. Whilst participation in this study was voluntary, the larger number of female participants reflects the higher incidence of dysphonia found in females in this cohort [14]. Variables included were those with a demonstrated link to dysphonia following preterm birth.…”

“…Dysphonia has been reported in preterm children, and associated with frequency of intubation, female gender, birth weight, gestational age and emergency intubation [13][14][15]. Dysphonia in adulthood, associated with left vocal cord paralysis following surgical ligation of patent ductus arteriosus in extreme prematurity, has also been documented [13].…”

Dysphonia in Very Preterm Children: A Review of the Evidence

“…Three large-scale observational studies reporting on the incidence of dysphonia in preterm children were identified [18,19,20]. There were no studies reporting treatment or therapy outcomes.…”

“…While the study of Røksund et al [19] was limited to a subsection of the extremely preterm population, the studies of Garten et al [20] and French et al [18] had access to the entire cohort of NICU discharges in the respective study centres, so selection bias is unlikely. Common factors associated with dysphonia across those studies were birth at <27 weeks' gestation, birth weight <1,000 g and intubation.…”