A nationwide survey on tracheostomy for very‐low‐birth‐weight infants in Japan

Abstract

Objectives Tracheostomy is indicated for very‐low‐birth‐weight infants (VLBWIs) with prolonged respiratory problems during the perinatal period. The objective of this study is to clarify the epidemiology and risk factors in VLBWIs with tracheostomy after birth in Japan. Methods A total of 40 806 VLBWIs were registered in the Neonatal Research Network of Japan database from 2003 to 2012. Among them, 34 674 infants (85%) survived over 28 days after birth and were subjected to this study. The clinical variables at birth, outcomes at hospital discharge and associated factors for tracheostomy were examined. Results The proportion of VLBWIs with tracheostomy did not increase during the study period (mean 36 cases per year, 0.93%). The rate of in‐hospital death over 28 days after birth did not differ between tracheostomized and non‐tracheostomized infants (2/324, 0.6% vs 314/34 350, 0.9%). Tracheostomized infants more frequently had severe or moderate bronchopulmonary dysplasia (BPD) (75.5% vs 26.0%, P < 0.01) and longer hospitalization (229 days vs 83 days, P < 0.01) than non‐tracheostomized infants. Tracheostomized patients showed higher comorbidities with hypoxic ischemic encephalopathy (odds ratio [OR] 10.98, P < 0.01), muscular disease (OR 10.95, P < 0.01), severe or moderate BPD (OR 7.79, P < 0.01), chromosomal abnormality (OR 4.43, P < 0.01) or sepsis (OR 1.78, P < 0.05) at hospital discharge than non‐tracheostomized patients. Conclusion We demonstrated the non‐increasing rate in tracheostomy for VLBWIs and such cases were associated with an excellent survival in Japan. These data provide evidence that more attentive care must be practiced in order to reduce the pulmonary and neuromuscular burdens of VLBWIs at birth.

Tracheostomies in term and preterm infants: A single‐center Canadian retrospective cohort

“…Our tracheostomy rate of 2.7% in preterm infants <29 weeks is higher than other cohorts, such as 0.68% for a preterm cohort, 0.93% for a very low birth weight cohort, and 0.7% and 0.1% for all NICU admissions cohorts 17,20–22 . Prolonged intubation and mechanical ventilation as risk factors for airway injury are well established 6,7 .…”

“…While recent retrospective cohort studies have examined the outcomes of infants with tracheostomies, to our knowledge, this is a unique cohort in the Canadian context. 9,10,[15][16][17][18][19][20][21][22][23] Canada has a singlepayer, provincially administered, publicly funded healthcare system. Alberta, Canada also has a comprehensive, publicly funded home care system for technology-dependent children.…”

“…While recent retrospective cohort studies have examined the outcomes of infants with tracheostomies, to our knowledge, this is a unique cohort in the Canadian context 9,10,15–23 . Canada has a single‐payer, provincially administered, publicly funded healthcare system.…”

“…Our tracheostomy rate of 2.7% in preterm infants <29 weeks is higher than other cohorts, such as 0.68% for a preterm cohort, 0.93% for a very low birth weight cohort, and 0.7% and 0.1% for all NICU admissions cohorts. 17,[20][21][22] Prolonged intubation and mechanical ventilation as risk factors for airway injury are well established. 6,7 In our cohort, compared with infants with other diagnoses, preterm infants had significantly more intubation attempts, planned extubations, and unplanned (unintended) extubations.…”

Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit

“…LOI is associated with (and may modify) risk of severe BPD, via inflammatory-mediated pathways, [30][31][32] and has been independently associated with tracheostomy placement in preterm infants. 33 BPD, growth failure and neurodevelopmental impairment are all identified risk factors for gastrostomy placement in preterm infants; all of these conditions are further associated with antecedent LOI. 22,[34][35][36] Although Serratia accounts for a low proportion of neonatal infections and has variable pathogenicity in infants (ranging from asymptomatic colonization to invasive disease), 5,19,37 we identified lower survival and higher risks of discharge morbidities (tracheostomy, gastrostomy and supplemental oxygen) associated with Serratia LOI, compared with non-Serratia LOI.…”