To Trach or Not To Trach: Long-term Tracheostomy Outcomes in Infants with BPD

Abstract

See Bonus NeoBriefs videos and downloadable teaching slides Infants born preterm who are diagnosed with bronchopulmonary dysplasia (BPD) demonstrate a wide spectrum of illness severity. For infants with the most severe forms of BPD, safe discharge from the hospital may only be possible by providing long-term ventilation via a surgically placed tracheostomy. Though tracheostomy placement in infants with BPD is infrequent, recent reports suggest that rates of tracheostomy placement are increasing in this population. Even though there are known respiratory and neurodevelopmental risks associated with tracheostomy placement, no evidence-based criteria or consensus clinical practice guidelines exist to inform tracheostomy placement in this growing and vulnerable population. An incomplete knowledge of long-term post-tracheostomy outcomes in infants with BPD may unduly bias medical decision-making and family counseling regarding tracheostomy placement. This review aims to summarize our current knowledge of the epidemiology and long-term outcomes of tracheostomy placement in infants with BPD to provide a family-centered framework for tracheostomy counseling.

Childhood Outcomes Following Discharge from a Referral Bronchopulmonary Dysplasia Program

“…9 If a tracheostomy was placed, these children were decannulated later than any cohort reported in the literature. 12 In sum, these data suggest that this referral cohort represents the most extreme manifestations of BPD, as would be expected of the children cared for by a quaternary-level referral program with a wide catchment area. Even in this severe cohort, a large majority of children who survived to NICU discharge survived at least through childhood.…”

“…Finally, outcome studies of severe BPD frequently lack a longitudinal dimension. 12 For many parents facing di cult clinical realities, "will this get better or worse?" and "how long will this last" are also important questions.…”