Developmental Outcomes of Very Preterm Infants with Tracheostomies

Abstract

Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the NICHD Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N=8,683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI, a composite of one or more of: developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed impact of timing, by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined, and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without [odds ratio (OR) adjusted for center 7.0 (95%CI, 5.2-9.5)]. After adjustment for potential confounders, odds of death or NDI remained higher [OR 3.3 (95%CI, 2.4-4.6)], but odds of death alone were lower [OR 0.4 (95%CI, 0.3-0.7)], among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life [adjusted OR 0.5 (95%CI, 0.3-0.9)]. Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes, and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

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

“…Cristea et al 17 have reported that median age of decannulation in severe BPD specific population is 37 months, and hence we plan to continue to follow these infants and assess the median age of decannulation in our cohort based on their underlying diagnosis. 17 In our cohort, mortality was 4% by 2 years of age and is consistent with DeMauro et al 18 who have shown that children with tracheostomy have significantly lower Readmission factors for T/V-dependent infants G Akangire et al risk of mortality compared with children without tracheostomies, especially in extremely preterm infants. Wootten et al 19 in 2006 reported 20% mortality in the first year of life in this population.…”

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

“…NDI was present when 1 or more of the components of the composite outcome were known to be present, or absent if no component was present. 9 …”

Patient characteristics are important determinants of neurodevelopmental outcome during infancy in giant omphalocele

“…Further, GO survivors with chronic ventilator dependent respiratory failure and/or tracheostomy had significant increased odds of neurodevelopmental impairments. Whether prolonged respiratory failure and/or tracheostomy itself puts GO children at risk for adverse outcome or reflects a more severe primary disease influencing neurological functioning remains debatable [12].…”