Have a premie who underwent surgical ligation of PDA, and several weeks later, shows significant elevation of the left hemidiaphragm. Has been stable on CPAP, but have not been able to wean the pressure. Had some difficulty extubating in the post-op period, but aside from the issue of the diaphragm, had a relatively uncomplicated post-op course.

You probably have a problem with nervus phrenicus, leading to paresis of the diaphragm. This nerve can be damaged during surgical PDA-closure. My experience is that this can resolve spontaneously, the nerve may not permanently damaged/cut off but only affected by suorrounding inflammation etc.

Just wait and see (and consult the surgeon and ask if he/she identified the nerve during surgery)

Edited March 22, 200916 yr by Stefan Johansson
Alexander - phrenicus is the right answer! Have corrected your post :)

Have a premie who underwent surgical ligation of PDA, and several weeks later, shows significant elevation of the left hemidiaphragm. Has been stable on CPAP, but have not been able to wean the pressure. Had some difficulty extubating in the post-op period, but aside from the issue of the diaphragm, had a relatively uncomplicated post-op course.

The cause of your diaphragmatic paralysis would be a left phrenic nerve injury which would have occured during the surgery

References

Diaphragmatic paralysis in extremely low birthweight neonates: Is waiting for spontaneous recovery justified?

Journal of Paediatrics and Child Health

Volume 38, Issue 1, Date: February 2002, Pages: 101-103

SM Jog, SK Patole

LINK

Malcolm WF, Hornik C, Evans A, Smith PB, Cotten CM. Vocal fold paralysis following surgical ductal closure in extremely low birth weight infants: a case series of feeding and respiratory complications. J Perinatol. 2008 Nov ;28(11):782-5.

LINK

thanks very much! I appreciate the input as well as the links. I realize the phrenic nerve injury is a potential complication of surgical ligation. However, I would have expected that to appear immediately. It seems unusual for it to occur several weeks later. I'm wondering if anyone else has encountered this?