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.