Incidence of Recurrent Laryngeal Nerve Palsy in Thoracic Surgery in Neonates

Infographic · Sep 2025 · 1 min read

In brief

Prospective study of 13 neonates undergoing thoracic surgery found 38.5% developed postoperative vocal cord paralysis, with lower weight and gestational age as significant risk factors. All cases were symptomatic, though feeding and hospital stay were not significantly impacted, emphasizing need for prevention strategies.

Vocal cord paralysis occurred in 38.5% of neonates after thoracic surgery at risk for recurrent laryngeal nerve injury.
Lower birth weight and younger gestational age are significant risk factors for postoperative vocal cord paralysis.
Postoperative vocal cord paralysis was always symptomatic, with stridor requiring intervention in 40% of affected patients.
Systematic laryngoscopy 15 days post-surgery is feasible for detecting vocal cord paralysis in neonatal thoracic surgery patients.
Associated congenital malformations did not increase the risk of postoperative vocal cord paralysis in this cohort.

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Objective

Postoperative vocal cord paralysis (VCP) is a known complication of thoracic surgeries that carry a risk of recurrent laryngeal nerve (RLN) injury. The primary aims of this study were to evaluate the prevalence of postoperative VCP, identify associated risk factors, and assess the impact on feeding and length of hospital stay in pediatric thoracic surgery.

Materials and Methods

We conducted a prospective, interventional, single-center study from September 2020 to January 2022. Preoperative laryngeal fibroscopy was performed, and children with pre-existing laryngeal immobility were excluded. Postoperative laryngeal fibroscopy was systematically performed 15 days after surgery to assess the incidence of VCP. Data were compared between children with and without VCP to identify risk factors and evaluate the impact on feeding and hospital length of stay.

Results

During the study period, 17 children (mean age 3.2 days; mean weight 2628 g) who underwent thoracic surgery at risk of RLN injury were included: 15 for esophageal atresia, 1 for ductus arteriosus ligation, and 1 for aortic arch surgery. Of these, 4 children were excluded because they could not undergo laryngoscopy at day 15. Postoperative fibroscopy was performed in the remaining 13 children, revealing VCP in 5 (38.5%). VCP was always symptomatic, with stridor requiring specific management in 2 patients. Weight and gestational age emerged as significant factors influencing the risk of postoperative VCP, while associated malformations did not impact VCP risk. No major effects on feeding or length of hospital stay were observed.

Conclusion

VCP is a common complication of thoracic surgery in children, highlighting the importance of its prevention due to potential severe consequences. Further research is needed to refine strategies for preventing VCP and improving outcomes in this patient population.

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