Noel French

Introduction. Dysphonia is a potential long-term complication of preterm birth. Childhood voice disorders caused by vocal hyperfunction resolve with pubertal changes to the vocal mechanism in many cases. In extremely preterm children, whose voice quality is affected by supraglottic hyperfunction adapted secondary to underlying structural laryngeal pathology sustained during neonatal intubation, the prognosis is unknown. Methods. A pilot study was conducted to assess the incidence and severity of dysphonia in children born at < 25 weeks’ gestation. Ten individuals, aged between 9.67 and 17.08 years, presented for repeat assessment in a replication and extension of the original study. The mean period between assessments was 2.85 (SD 0.38) years. The primary outcome measure was the severity score on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), with the Acoustic Voice Quality Index score as the secondary outcome measure. Scores on the Pediatric Voice Handicap Index were also compared. Results. Perceptual dysphonia severity scores were significantly lower on repeat assessment, but no differences were observed in objective or quality of life scores. Individual variation was observed: the difference in CAPE-V scores ranged from –36 to + 1. No participant presented with normal voice quality on repeat assessment. Discussion. Analysis of group data masked individual variability in this series. Mechanisms underlying such individual variation are currently unknown. These data suggest that dysphonia is persistent in extremely preterm children. Conclusion. Further investigation is warranted to elucidate the progression of voice disorders in extremely preterm children, to inform prognostic predictors and treatment decisions.

Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted. This paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps. A substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.

Many more children than ever before survive and thrive following preterm birth (Saigal & Doyle, 2008). To date, research has focussed on medical, developmental, neurological, and behavioral outcomes. As the number of surviving children increases and survivors reach school age and beyond, it has become apparent that many children experience difficulties with voice production (French et al., 2013). Following preterm birth, endotracheal intubation may be necessary to deliver surfactant or relieve respiratory distress during the neonatal period (Ho, Subramaniam, Henderson-Smart, & Davis, 2002). Intubation injury to the larynx and resultant dysphonia are well described in the literature (Bray, Cavalli, Eze, Mills, & Hartley, 2010). This article presents a brief review of the literature relevant to intubation-related injury following preterm birth and 2 case studies of voice outcomes following a trial of behavioral voice therapy in extremely preterm children who were intubated.

BACKGROUND AND OBJECTIVES: Voice abnormality is a frequent finding in school age children born at 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 voice-protective strategies in infants requiring multiple episodes of intubation.

Abstract:  While there is general agreement with the framework of the consensus statements, it is at the margins of the ‘grey zone’, particularly at 23 weeks of gestation, that practice in other states appears to differ from practice in New South Wales (NSW)/Australian Capital Territory (ACT). This is evidenced by the lower regional survival in NSW/ACT at 23 weeks compared with other contemporaneous regional Australian cohorts, reflecting the discouragement of active intervention in NSW/ACT at this gestation. At the other end of the ‘grey zone’, surely active intervention, including prenatal transfer to a tertiary obstetric centre, should always be given to an otherwise uncomplicated 25‐week infant? At any of these gestations, where infants survive, the majority are not severely disabled, leading us in this state to support initiation of intensive care to infants of marginal gestations where informed parents wish us to do so. The consensus conference questions and response rates by professional group should be published in full.