Abstract: Background：The clinical characteristics of neonatal vocal cord paralysis (VCP) and the factors influencing shortterm prognosis remain uncertain. Objective：To investigate the factors influencing the discharge outcomes of neonatal VCP. Design：Retrospective cohort study. Methods：The study included neonates diagnosed with VCP by medical history, clinical signs, and bronchoscopy results in the Neonatal Intensive Care Unit (NICU) of Jinan Children's Hospital between April 2013 and January 2022. The cases were divided into two groups: the improved discharge group (those who did not require invasive ventilation and were able to suckle independently at discharge) and the nonimproved discharge group. The data collected for univariate analysis included maternal data of age, gestational hypertension, gestational diabetes, mode of delivery, premature rupture of membranes, nuchal cord, umbilical cord torsion, and amniotic fluid conditions; neonatal data of gender, gestational age, birth weight, 1minute Apgar score, associated malformations, and laryngeal obstruction; VCP etiology of birth injury, neurogenic, iatrogenic, and idiopathic; unilateral VCP and bilateral VCP (complete paralysis and incomplete paralysis) by bronchoscopy; and prognosis at the time of discharge. Variables with a P-value <0.10 in the univariate analysis were included as independent variables in the multivariate logistic regression analysis. Main outcome measures：Factors influencing the improved discharge. Results：A total of 133 cases of neonatal VCP were included in the analysis. The age of the first bronchoscopy examination was 6 (4, 12) days, the admission age was 13.0 (3.0, 20.5) days, and the gestational age was 39.0 (38.0, 40.0) weeks. There were 71 cases (53.4%) with associated malformations, 43 cases (32.3%) with unilateral VCP and 90 cases with bilateral VCP including 57 cases of incomplete paralysis and 33 cases of complete paralysis. The improved discharge group consisted of 96 cases (72.2%), while the non-improved discharge group had 37 cases, including 28 cases with difficulty weaning, 8 cases with tracheostomy (7 cases of bilateral incomplete paralysis and 1 case of bilateral complete paralysis). All tracheostomized patients were successfully weaned from positive pressure ventilation and discharged. Among them, 4 cases had restored vocal cord mobility within 9 months, and the remaining 4 cases were lost to follow-up. Thirty-seven cases had feeding-swallowing-breathing coordination disorders. Multivariate logistic regression analysis was performed on variables with a P-value <0.10 in the univariate analysis, including cesarean section, polyhydramnios, birth weight, low Apgar score, neurogenic injury, laryngeal obstruction, and type of vocal cord paralysis. The results showed that bilateral incomplete paralysis was a negative factor for improved discharge in neonates with VCP (OR=6.785, 95% CI: 2.191-21.013, P=0.001). Conclusion：Neonates with bilateral VCP, especially for the incomplete ones have poorer discharge outcomes, and tracheostomy can be used as a palliative treatment option.

Key words: Vocal cord paralysis, Neonate, Incomplete paralysis, Complete paralysis, Clinical characteristics, Prognosis