Risk factor analysis for mortality among infants requiring tracheostomy

Strang, Abigail; Briddell, Jenna W.; Barth, Patrick; Shah, Udayan K.; Chidekel, Aaron

doi:10.1002/ppul.24064

Cited by 20 publications

(24 citation statements)

References 32 publications

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“…Tracheostomy‐related complications were equally seen in preterm and extremely preterm neonates. Prior studies report mortality rate as low but not insignificant . Strang et al found that in infants ≤12 months of age, the mortality rate was increased in infants requiring tracheostomies with congenital heart disease but was unchanged in infants with BPD.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross‐Sectional Analysis

et al. 2019

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Objectives/Hypothesis Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased. Study Design Retrospective cross‐sectional analysis. Methods We analyzed the 2006 to 2012 Kids’ Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD. Results The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002). Conclusions Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis. Level of Evidence 4 Laryngoscope, 130: 2056–2062, 2020

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Section: Discussionmentioning

confidence: 99%

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross‐Sectional Analysis

et al. 2019

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“…12,[15][16][17][18] Additionally, associated morbidities resulting from both the severity of lung disease as well as complications from prolonged exposure to an artificial airway include highly variable but significant rates of neurodevelopmental impairment and structural upper airway disease. [18][19][20][21][22][23][24] Roughly half of the infants born extremely premature develop moderate or severe BPD. 3,4,9 The incidence is rising, indicating that an increasing number of infants will require prolonged ventilatory support, potentially via tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia

House

Nathan

Bhuiyan

et al. 2021

Pediatric Pulmonology

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Objective: The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.Study Design: We retrospectively reviewed a single-center 4-year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post-discharge respiratory outcomes, and survival were examined up to at least 5 years of age.Results: At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty-six infants (94%) had long-term follow-up.Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow-up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction. Conclusion:Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.

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“…There are few directly comparable studies to examine long‐term mortality rate infant tracheostomy patients given that the majority of studies vary in range of ages included in analysis, tracheotomy indications, and length of follow‐up. Our mortality rate (15.13%) falls within the lower end of the studies on preterm and infant tracheostomy, who cite a mortality rate ranging from 14.2% to 23.53% 4,7,25,26 . However, it remains at upper limit of overall all‐cause mortality rates associated with all ages of pediatric tracheostomy ranging from 1.5% to 18.9% 11,26–30 .…”

Section: Discussionmentioning

confidence: 64%

“…Interestingly, there appears to be a lack of consensus on long‐term outcomes in children with tracheostomy and BPD. Some studies report comparable or decreased rates of mortality among pediatric tracheostomy patients with BPD compared to those without BPD 22,26,31,32 . Other studies report that prematurity and BPD are independent predictors of mortality within this population 33,34 .…”

Section: Discussionmentioning

confidence: 99%

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

et al. 2021

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Objectives//Hypothesis To characterize long‐term outcomes in pediatric patients requiring tracheotomy in the first year of life. Study Design Retrospective case series. Methods A retrospective longitudinal registry of tracheostomy patients was queried for patients who underwent tracheotomy from birth to 11 months. Primary outcomes were decannulation and survival. Secondary outcomes included neurocognitive quality of life assessed with the PedsQL Family Impact Module (scored from worst to best, 0 to 100 points). Results The study included 337 children. Thirty (8.90%) were neonates and 307 (91.10%) were infants. The population was 56.08% male (n = 189), and the racial and ethnicity composition were equally distributed (29.97% White, 31.45% Black, and 31.16% Hispanic). Significant differences between neonates and postneonates included birth weight in grams (2,731.40 vs. 1,950.44, P < .05), extreme prematurity (13.33% vs. 38.88%, P = .01), upper airway obstruction (80.00% vs. 42.67%, P < .05), and the need for mechanical ventilation (40.00% vs. 83.71%, P < .05). Despite these differences, long‐term outcomes were similar: decannulation (X2 = 2.19, P = .14), death (X2 = 2.63, P = .11), and neurocognitive quality of life (X2 = 2.63, P = .27). Having a child with a tracheostomy caused the most problems with being physically tired (mean = 75.32 ± 3.90), emotional frustration (mean = 77.31 ± 5.05), and worry (mean standard deviation = 74.23 ± 6.48). Conclusion There were demographic differences between neonatal and infantile tracheostomy patients, but they did not affect long‐term outcomes. The presence of a tracheostomy caused a significant impact on a family's quality of life. Level of Evidence 3 Laryngoscope, 131:2115–2120, 2021

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Risk factor analysis for mortality among infants requiring tracheostomy

Cited by 20 publications

References 32 publications

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross‐Sectional Analysis

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross‐Sectional Analysis

Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

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