Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age

Akangire, Gangaram; Manimtim, Winston M; Nyp, Michael F.; Townley, Nick; Dai, H; Norberg, Michael; Taylor, Jane B.

doi:10.1038/jp.2017.54

Cited by 28 publications

(41 citation statements)

References 20 publications

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“…In our previous study, we reported that oxygen and diuretic use in infants with BPD increased around 1 year of age and then gradually decreased by 2 years of age. 6 In this study, we found a similar trend for gastrointestinal and renal medications; however, cardiac medications, endocrine medications, neurologic medications, and inhaled corticosteroids did not decrease significantly over the 3-year period. A probable reason for this difference could be the weaning of diuretics for severe BPD patients.…”

Section: Discussionsupporting

confidence: 61%

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Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

et al. 2020

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Background Outcome of infants with tracheostomy have not been well described in the literature. Our objective was to describe the respiratory, growth, and survival outcomes of infants with tracheostomy. Methods A retrospective study was conducted on 204 infants born between 2005 and 2015 with tracheostomy at <1 year of age and follow-up in the Infant Tracheostomy and Home Ventilator Clinic up to 4 years of age. Results The mean age at tracheostomy was 4.5 months with median age of 3 months. Median age of decannulation was 32 months. The time from tracheostomy placement to complete discontinuation of mechanical ventilation was 15.4 months and from tracheostomy to decannulation was 33.8 months. Mortality rate was 21% and median age of death was 18 months. Preterm infants with acquired airway and lung disease (BPD) and born at <28 weeks’ gestation had a significantly higher survival rate compared to term infants. The z -scores for weight and weight for length improved from the time of discharge (mean chronological age 6.5 months) to first year and remained consistent through 3 years. Conclusions Premature infants had a higher rate of discontinuation of mechanical ventilation and decannulation compared to term infants. These infants showed consistent growth and comparable survival rate. Impact Infants with tracheostomy and ventilator dependence followed in a multidisciplinary clinic model may have improved survival, growth, and earlier time to decannulation. Preterm infants with acquired airway and lung disease (BPD) with tracheostomy had a higher survival rate compared to term infants with various tracheostomy indications. The age at tracheostomy in infants was 4.5 months and of decannulation was 37 months. Time from tracheostomy to complete discontinuation of mechanical ventilation was 15.4 months. Addition of this data to the sparse literature will be crucial in counseling the families and education of medical staff.

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Section: Discussionsupporting

confidence: 61%

“… 3 – 5 Prior studies indicate that rehospitalization, equipment malfunction, and tracheostomy at <1 year of age are significant risk factors for mortality. 1 , 6 …”

Section: Introductionmentioning

confidence: 99%

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

et al. 2020

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“…3-5 CWT are a growing population as pediatric medical advances result in increased survival of children with critical airways and chronic respiratory failure. 6-9 CWT were previously thought to be too complex to be cared for at home and were hospitalized for long periods. 10 Now increasing recognition supports that CWT can be successfully cared for at home with proper social, economic, and medical supports.…”

Section: Introductionmentioning

confidence: 99%

“…20,21 The combination of significant medical complexity, potential for life-threatening complications, 22 and lack of standardization of care transitions and training for caregivers/home nursing agencies place CWT at high risk for morbidity and mortality fostering dependence on crisis-driven care. 6,9,23,24 CWT have high hospital readmission rates particularly following discharge after initial tracheostomy placement with rates varying from 20% to 50% in the first 3 months. 8,[25][26][27] High readmission rates contribute to already elevated levels of caregiver burden and increased health care costs, 19,24,28,29 and are costly and stressful for patients/families.…”

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confidence: 99%

Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Mai

Davis

Hamilton

et al. 2020

Clin Pediatr (Phila)

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This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.

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“…This lower rate of RSV infection may have been due to strict compliance with Synagis administration in tracheostomized and ventilator-dependent infant's medical home clinic where NICU physicians were the primary pediatricians for this cohort of infants. 16 Interestingly, there were no deaths reported after discharge from the NICU in the severe BPD cohort for this study. This finding was also noted in a BPD study done from 2010 to 2013 17 where there were seven deaths reported post NICU discharge but only in the mild/ moderate BPD groups.…”

Section: Discussionmentioning

confidence: 74%

Clinical Outcomes among Diagnostic Subgroups of Infants with Severe Bronchopulmonary Dysplasia through 2 Years of Age

et al. 2018

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An NICU diagnosis of neurologic abnormality, necrotizing enterocolitis, invasive NICU infection, dysphagia, and O at NICU discharge differed between the three subgroups of severe BPD. The most common cause of readmission was viral respiratory tract infection. Inhaled steroid use remained stable over time, while oxygen use and diuretic use declined over time. Risk factors for readmission in the entire cohort included g-tube, O use, and diuretic use at 12 months. There was no significant difference in readmission rates between the three BPD subgroups.

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Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age

Abstract: The risk for rehospitalization for infants requiring tracheostomy and ventilator support was affected by prolonged oxygen use, prolonged ventilator dependence, inhaled steroid use and equipment malfunction, and was equally distributed throughout the first 2 years of life.

Cited by 28 publications

References 20 publications

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Identifying Caregiver Needs for Children With a Tracheostomy Living at Home

Clinical Outcomes among Diagnostic Subgroups of Infants with Severe Bronchopulmonary Dysplasia through 2 Years of Age

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