Prematurity with Unilateral Diaphragmatic and Vocal Cord Paralysis Following Patent Ductus Arteriosus Ligation

Patent ductus arteriosus (PDA) remains an important cardiovascular problem in term and pre-term infants. Consequent hemodynamically significant left-to-right shunt may impact all organ systems. There are several kinds of interventions to minimize adverse effects, including cyclooxygenase (COX) inhibitors, paracetamol, and surgical ligation. Surgical ligation is usually performed when medical therapy with COX inhibitors fails or is contraindicated. However, some complications like intra-operative bleeding, pneumothorax, left recurrent laryngeal nerve paralysis, respiratory compromise, infection, chylothorax, intracranial hemorrhage, and left phrenic nerve injury, may happen. This report is on a pre-term infant with clinically significant PDA. After PDA ligation, he suffered from paralysis of the left diaphragm and left vocal cord, with associated respiratory distress, ventilator support dependence, prolonged hospitalization, poor body weight gain, and feeding difficulty. Routine survey of diaphragmatic dysfunction and vocal cord paralysis should be arranged for infants who undergo surgical ligation. (J Pediatr Resp Dis 2015;11:52-58)