Objectives To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. Methods We performed a single‐institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan–Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. Results This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation‐dependent (68% vs. 54%, P < .001). The 5‐year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5‐year survival rate post‐tracheostomy for preterm was 79% and for extremely preterm was 73%. The log‐rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). Conclusion This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. Level of Evidence 3b Laryngoscope, 131:417–422, 2021

Acute pediatric stroke is a medical emergency requiring prompt recognition and treatment because quicker treatment improves neurologic outcomes and reduces excess resource usage on stroke mimics (non-stroke diagnoses). There is a clear need to better differentiate between strokes and their mimics. We performed a single center retrospective cohort study using data from March 1, 2017 to December 31, 2020. We included pediatric patients (> 1m to < 18y) evaluated in the tertiary children’s hospital ED for a stroke team activation. We compared clinical features for patients with stroke and those with a stroke mimic. Of 179 children included in the study (55% female, mean age 11.2y, SD 5.7y), 38 children (21% of total patients, 50% female, mean age 10.5 SD, 6.2 years) were diagnosed with stroke. Strokes included acute ischemic stroke (AIS) (73.7%), hemorrhagic stroke (HS) (18.4%), and cerebral venous sinus thrombosis (CVST) (10.5%). The most common stroke mimics were seizure (14.5%), headache (10.5%), Bell's palsy (5.6%), and conversion disorder (2.7%). Compared to mimics, stroke patients were less likely to have a history of neurosurgery (16.3% mimic vs 2.6% stroke, p=0.028) and more likely to have altered level of alertness (7.7% vs 18.4%, p=0.001), abnormal coordination (15.7% vs 36.4%, p=0.036), abnormal muscle strength (33.1% vs 57.9%, p=0.005) and abnormal reflexes (18.9% vs 43.8%, p=0.018). Of note, there were no significant differences in stroke and mimics for: age, sex, race, ethnicity, basic metabolic panel or CBC, and time from last seen well. Differentiating between strokes and mimics remains difficult without comprehensive diagnostic testing. Our study found that stroke patients are more likely present with altered level of alertness as well as abnormal coordination, muscle strength, and reflexes.