Objective To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit (NICU). Study design We analyzed an electronic medical record from 348 NICUs from 1997–2012, and evaluated the associations between infant demographics, diagnoses, and pre-tracheostomy cardio-pulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. Results We identified 885/887,910 (0.1%) infants who received a tracheostomy at a median postnatal and postmenstrual age of 72 days (25th, 75th percentile 27, 119) and 42 weeks (39, 46) respectively. The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia [396/885 (45%)], other upper airway anomalies [202/885 (23%)], and laryngeal anomalies [115/885 (13%)]. In-hospital mortality after tracheostomy was 125/885 (14%). On adjusted analysis, gestational age (GA) near term, small for gestational age (SGA) status, pulmonary diagnoses, number of days of FiO2>0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P<0.001), but has remained stable since. Conclusions Tracheostomy is uncommonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include GA near term, SGA, and pulmonary diagnoses.

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