A multidisciplinary chronic lung disease team in a neonatal intensive care unit is associated with increased survival to discharge of infants with tracheostomy

Abstract

Objective To determine if multidisciplinary team-based care of severe BPD/CLD infants improve survival to discharge. Design/methods Retrospective review of severe BPD/CLD infants cared for by dedicated multidisciplinary CLD team using consensus-driven protocols and guidelines. Results Total of 267 patients. Median gestational age was 26 weeks (IQR 24, 32); median birth-weight was 0.85 (IQR 0.64, 1.5). Twenty-four percent were preterm with severe BPD, 46% had other primary respiratory diseases (none BPD diseases). Total number of patients, proportion of patients with tracheostomy, prematurity, and genetic diagnoses increased over time. 88.8% survived to discharge. Unadjusted logistic regression showed that tracheostomy was not associated with odds of death; secondary pulmonary hypertension was associated with odds of tracheostomy (OR = 1.795 p value = 0.0264), or death (OR = 8.587 p value = <0.0001), or tracheostomy + death (OR = 13.58 p value = 0.0007). Conclusions Over time, mortality improved for infants with tracheostomy cared for by a multidisciplinary severe BPD/CLD team. Secondary pulmonary hypertension was associated with tracheostomy, or death, or tracheostomy + death.

Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation

“…In general, the mortality rate of infants with severe BPD before and after tracheostomy is higher in the NICU due to the many comorbidities that these infants may develop during the acute phase of their disease process 13,15,20,21,25 . After NICU discharge, the mortality rate is significantly variable and ranges from as low as 3% to as high as 22% 14,15,18 .…”

“…The decision to offer tracheostomy in infants with severe BPD is arrived at after a multi‐ and interdisciplinary team consensus and parental acceptance. Since that time, we have seen an increase in the number and survival of infants with sBPD receiving tracheostomy 21 . The same group of dedicated neonatologists follow these infants in our infant tracheostomy and home ventilator clinic up to 4 years of age as described in our previous studies 13,21 .…”

“…Since that time, we have seen an increase in the number and survival of infants with sBPD receiving tracheostomy 21 . The same group of dedicated neonatologists follow these infants in our infant tracheostomy and home ventilator clinic up to 4 years of age as described in our previous studies 13,21 . Our primary goal therefore was to report the respiratory outcomes of infants with severe BPD who received tracheostomy and were followed by a dedicated hospital‐based, neonatologist‐led, inter‐ and multidisciplinary, family‐centered medical home; second, to describe the medication exposure as well as the rate of rehospitalization of infants with severe BPD receiving tracheostomy; third, to describe the growth patterns of these chronically ventilated infants at home; and finally, to identify biological and clinical factors in these infants that may be favorable for tracheostomy decannulation.…”

Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

“…BPD, or chronic lung disease (CLD), comprises almost 50% of infants needing tracheostomy, followed by congenital or acquired airway abnormalities (vocal cord paralysis, tracheobronchomalacia (TBM), subglottic stenosis), craniofacial anomalies, and cardiac, neurologic or musculoskeletal, and genetic disorders (19,21,22). Recently, in addition to BPD or CLD, rare genetic anomalies in infants are increasing indications for receiving tracheostomy to sustain survival outside of intensive care settings (1,23,24). Specific to infants with severe BPD, tracheostomy is performed based on several factors including center-specific practices, corrected age and clinical status of the infant, and parental preferences (5,19).…”

“…The development of BPD-associated pulmonary hypertension has been found to be independently associated with the need for tracheostomy in infants with severe BPD ( 24 ). Poor growth and delayed development may also contribute to the need for long-term mechanical ventilation through a tracheostomy in infants with severe BPD.…”