Airway Management in the Premature Infant

Abstract

Out of 262 premature newborn patients admitted with a diagnosis of respiratory distress, it was necessary to treat 70 with a ventilator. Of these 70, 25 eventually underwent tracheostomy. Indications for tracheostomy were that of an infant needing prolonged endotracheal intubation greater than one week. The procedure itself was easily performed and an overall complication rate of 7% was the result. Of the patients who underwent tracheostomy, 8% had significant complications. There was no death attributable to the treatment regime. We feel, therefore, that a combination approach starting with the endotracheal tube and progressing to tracheostomy when necessary, provided the best care for premature infants requiring intensive airway management.

Failed extubation in the neonatal intensive care unit

“…Concomitantly, there have been significant changes in the management of the neonatal airway [4]. Fewer neonates are now requiring tracheostomy, with rates decreasing from 2.7% in 1978 to 0.55% in 2001 [1,5,6]. The indication for a tracheostomy in a neonate has shifted from upper airway obstruction to prolonged intubation and failed extubation [2,7,8].…”

Tracheostomy in Preterm Infants

“…The average birth weight has risen slightly from 1670 to 1807 g in the same period. 19,20 However, rapid advances in neonatology currently enable the survival of larger numbers of extremely premature infants with very low birth weights. Many of these neonates weigh less than 500 g at birth, and about 1 to 3 kg several months later.…”

“…12,21 More recent reports have shown a trend toward prolonged mechanical ventilation as the most common indication for tracheostomy in infants. 2,14 In 1978, Heroy et al 19 reported a 2.7% incidence of tracheostomy among patients admitted to an NICU. A total of 35.7% of the children who underwent mechanical ventilation required tracheostomy.…”

Description of the patients with tracheostomy discharged from the Intensive Care Service of the National Children´s Hospital. (January 1996 – December 2007)

“…3 This is why more recent studies report a frequency decrease for this procedure from 2,7% in 1978, to 0,55% in 2001. [7][8][9] The objective for this study was to describe the epidemiological and clinical characteristics, the indications and complications for the discharged tracheostomized children at the NICS of the National Children´s Hospital "Dr Carlos Sáenz Herrera" (HNN).…”