Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia

Abstract

ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

“…This result corroborates previously published results, which also show it to be the most common indication for neonatal tracheostomy . Indeed, approximately 20% of infants with BPD who are referred to regional neonatal intensive care units die or receive a tracheostomy before discharge from the neonatal intensive care unit . Currently, no uniform indications for tracheostomy in this specific population exist, despite a recent publication from the interdisciplinary Bronchopulmonary Dysplasia Collaborative …”

“…[18][19][20] Indeed, approximately 20% of infants with BPD who are referred to regional neonatal intensive care units die or receive a tracheostomy before discharge from the neonatal intensive care unit. 21,22 Currently, no uniform indications for tracheostomy in this specific population exist, despite a recent publication from the interdisciplinary Bronchopulmonary Dysplasia Collaborative. 22,23 There are multiple limitations in using the ACS-NSQIP-P. Mortality and morbidity rates of patients after 30 days are not captured.…”

“…21,22 Currently, no uniform indications for tracheostomy in this specific population exist, despite a recent publication from the interdisciplinary Bronchopulmonary Dysplasia Collaborative. 22,23 There are multiple limitations in using the ACS-NSQIP-P. Mortality and morbidity rates of patients after 30 days are not captured. As others have noted, functional outcomes, surgical technique, nor operative indications are recorded.…”

Acute Post-Tracheostomy Clinical Decompensations in Infants—Are There Predictive Markers?

“…Mandy et al reported a mean PMA of 51 weeks, while Murthy et al and Cheng et al reported mean PMAs of 46 weeks and 49 weeks, respectively. 1,14,15 We acknowledge that our PMA at time of tracheostomy is earlier than what is reported in the literature. A consensus practice within our multidisciplinary team caring for these infants is based on the large multicenter retrospective study from the NICHD NRN that included infants born at less than 30 weeks' gestation from 2001 to 2011, 304 of 8683 (3.5%) infants required tracheostomy.…”

How do neonatal units within the Australian and New Zealand Neonatal Network manage ex‐preterm infants with severe chronic lung disease still requiring major respiratory support at term?

“…Finally, there was a limited response regarding the practice of tracheostomy, and no unit offered a guideline covering their practice. There are recognised variations regarding timing and practice around this, but outcomes appear to justify tracheostomy use for ongoing respiratory support …”