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

Wang, Cynthia S.; Kou, Yann Fuu; Shah, Gopi; Mitchell, Ron B.; Johnson, Romaine F.

doi:10.1002/lary.28304

Cited by 34 publications

(50 citation statements)

References 21 publications

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“…Black children are disproportionately affected by preterm birth and often are an independent risk factor for adverse outcomes 3,10,22 . We found that black children were more likely to be extremely preterm and have bronchopulmonary dysplasia.…”

Section: Discussionmentioning

confidence: 70%

“…Research indicates that the survival of preterm and extremely preterm infants is increasing 9,14 . Research also shows that many of these children need tracheostomies until early childhood to allow time for the conditions that lead to the tracheostomy to resolve or improve 10,15 . Despite these concerns, the time it takes to decannulate and the survivors' QOL among preterm and extremely preterm infants with tracheostomy are understudied.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed that, despite improvements in survival, the rate of BPD has increased among a case series of extremely preterm infants 9 . Another study also suggested that tracheostomy rates may be increasing among extremely preterm infants with BPD as well 10 …”

Section: Introductionmentioning

confidence: 99%

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A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

et al. 2020

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Objectives To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. Methods We performed a single‐institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan–Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. Results This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation‐dependent (68% vs. 54%, P < .001). The 5‐year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5‐year survival rate post‐tracheostomy for preterm was 79% and for extremely preterm was 73%. The log‐rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). Conclusion This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. Level of Evidence 3b Laryngoscope, 131:417–422, 2021

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

et al. 2020

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“…These results were consistent with those Cristea et al reported on the outcomes for infants with severe BPD with a median age of complete discontinuation of mechanical ventilation at 24 months of age and decannulation at 37.5 months of age. 12 , 18 The decannulation rates for pediatric tracheostomy patients, as published in the literature, range from 31 to 75%. 19 – 26 Infants with severe BPD have increased chance of decannulation and survival due to improved care and ventilation to support constant lung growth.…”

Section: Discussionmentioning

confidence: 99%

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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“…With advanced technology in health care, survival of extremely low birth infants has been increasing and consequently morbidity associated with prematurity like bronchopulmonary dysplasia (BPD) is on a rise [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of neonates with tracheostomy secondary to bronchopulmonary dysplasia

Upadhyay

Vallarino²,

Talati

2020

BMC Pediatr

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Background: Bronchopulmonary dysplasia (BPD) is a disease that can affect preterm neonates. Infants with severe BPD may develop pulmonary hypertension (PHN) and may require chronic mechanical ventilation with tracheostomy. The outcomes of these infants have not been studied well. We proposed to review survival and outcomes of infants requiring tracheostomy secondary to severe BPD in our NICU at 24 months. Methods: We reviewed infants' charts who were diagnosed with BPD that underwent tracheostomy from January 2011 to May 2016 at our children's hospital NICU. Data were recorded from hospital stay as well as from follow up clinics. Institutional review board approval was obtained prior to beginning of study. Results: Forty-one babies (37 during initial hospitalization and 4 subsequently) requiring tracheostomy were identified from our database. Median gestational age at birth was 26 weeks (25-27 IQR), mean birthweight of 731 g (±245 SD) and 32% were small for gestational age (SGA). Median age of tracheostomy placement was 168 days (108-197 IQR), and median PMA 48 wks (40-56 IQR). 26% of infants requiring tracheostomy also had subglottic stenosis along with BPD. 34 infants (83%) survived to discharge from NICU. 66% (27/41) of our patients had a composite outcome of death, ventilator dependency and/or poor neurodevelopmental outcome at 2 years. We found that a higher respiratory severity score at the time of tracheostomy placement and later post-menstrual age at admission to level IV NICU was associated with a worse outcome. Small for gestational age infants were found to have worse outcomes as well. 41% (13/32) of infants had more than 3 hospital admissions after discharge. Conclusions: In our cohort about 80% of infants with severe BPD and tracheostomy survived to discharge with need for prolonged home ventilation in more than half of the survivors. Later postmenstrual age at admission to level 4 NICU was associated with a worse outcome. Our retrospective data may be inadequate to determine the causal relationship between postmenstrual age at admission and outcome. These patients continue to have high morbidity and recurrent hospitalizations.

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

Cited by 34 publications

References 21 publications

A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

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

Outcomes of neonates with tracheostomy secondary to bronchopulmonary dysplasia

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