Feeding Outcomes in Tracheostomy-Dependent Children with Bronchopulmonary Dysplasia

Abstract

Objective(s): Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants. Tracheostomy is performed in infants with BPD who are unable to wean from ventilator support. Prior studies have highlighted delayed oral feeding in BPD but have excluded patients with tracheostomy. This study aims to characterize long-term feeding outcomes in this group of patients. Materials and Methods: This is a single-institution retrospective cohort study of infants diagnosed with BPD who underwent tracheostomy during their birth hospitalization admission between January 2016 and December 2022. Surviving patients were followed-up for at least 2 years. Data were obtained from hospital, clinic, and feeding therapy encounters. Results: A total of 71 patients were included in this study, and tracheostomy was performed at a median age of 55.6 weeks post-menstrual age (PMA). The overall mortality was 31% (n = 22); 25% of which occurred prior to discharge (n = 18/71). The first oral feed occurred at a median 66 weeks PMA, and 31% of patients achieved full oral feeds at a median age of 3.2 years PMA. Successful achievement of full oral feeds was associated with younger age at tracheostomy/gastrostomy placement and less severe BPD. Conclusions: Patients with BPD and tracheostomy have multiple risk factors for poor feeding progression. When compared to data on feeding in BPD or tracheostomy infants alone, oral feeding milestones were found to be delayed. Future studies are needed to understand the optimal timing of tracheostomy in infants with BPD. Providers should manage family expectations of oral feeding progression following tracheostomy. Level of Evidence: 3.