Tracheostomy in the Extremely Premature Neonate: A Multi‐Institutional Study

Abstract

Objective (1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants. Study Design Pooled retrospective analysis of charts. Setting Academic children’s hospitals. Subjects and Methods The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children’s hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed. Results: The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment ( P = .002) and death ( P = .03). Conclusions Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.

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

“…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.…”

“…Despite our institution offering intensive resuscitation for infants at periviable gestations (22 +0 –24 +6 weeks), these infants represented only 25% of the cohort, and 3% of all infants admitted at <25 +0 weeks. Preterm infants <25 weeks GA comparably formed only 28% of a tracheostomized infants cohort and 36% of an extremely preterm tracheostomized infant cohort 9,13 . The high proportion of infants born at 25 weeks with a tracheostomy may have resulted from almost universal intensive delivery room resuscitation and higher long‐term survival of these infants compared with younger infants.…”

“…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.…”

“…weeks GA comparably formed only 28% of a tracheostomized infants cohort and 36% of an extremely preterm tracheostomized infant cohort. 9,13 The high proportion of infants born at 25 weeks with a | 997 tracheostomy may have resulted from almost universal intensive delivery room resuscitation and higher long-term survival of these infants compared with younger infants.…”

“…While mortality directly related to neonatal tracheostomy is low, factors such as term status, birth weight, and indication for tracheostomy have been associated with differences in survival 2,5,13 . Additionally, comorbidities are common in tracheostomized infants 9 . As outcomes associated with neonatal tracheostomies are diverse, it is crucial to examine multiple cohorts and time points.…”