Tracheostomy Placement in Children Younger Than 2 Years

Mahida, Justin B.; Asti, Lindsey; Boss, Emily F.; Shah, Rahul K.; Deans, Katherine J.; Minneci, Peter C.; Jatana, Kris R.

doi:10.1001/jamaoto.2015.3302

Cited by 90 publications

(30 citation statements)

References 26 publications

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“…Neonatal age, cardiac risk factors, and intraventricular hemorrhage were identified as independent risk factors for major complications in a tracheostomy placed in children younger than 2 years. 16 Although Black children more frequently had a diagnosis of intracranial injury and short gestation, we found no difference in complication rates compared with other groups. Using 2003 to 2016 KID, it was difficult to determine the time to tracheostomy or the time to discharge after tracheostomy.…”

Section: Resultscontrasting

confidence: 58%

“…Black children with laryngeal stenosis, BPD, injury, other comorbidities or limited access to outpatient care may have contributed to why Black children had an extended length of stay. Neonatal age, cardiac risk factors, and intraventricular hemorrhage were identified as independent risk factors for major complications in a tracheostomy placed in children younger than 2 years 16 . Although Black children more frequently had a diagnosis of intracranial injury and short gestation, we found no difference in complication rates compared with other groups.…”

Section: Discussioncontrasting

confidence: 50%

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The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Brown

Shah

Mitchell

et al. 2020

Otolaryngol.--head neck surg.

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Objective In 2012, Black or African American children constituted 21% of pediatric tracheostomies while representing approximately 15% of the US population. It is unclear if this discrepancy is due to differences in associated diagnoses. This study aimed to analyze the incidence of pediatric tracheostomy in the United States from 2003 to 2016 and to determine the odds of placement among Black children when compared with other children. Study Design Retrospective. Setting Academic hospital. Subjects and Methods We used the 2003 to 2016 Kid Inpatient Database to determine the incidence of pediatric tracheostomy in the United States and determine the odds of tracheostomy placement in Black children when compared with other children. Results A total of 26,034 pediatric tracheostomies were performed between 2003 and 2016, among which, 21% were Black children. The median age was 7 years (interquartile range [IQR] = 0 to 17); 43% were ≤2 years old, and 62% were male. The most common principal diagnosis was respiratory failure (72%). When compared with other children, Black children were more likely to undergo tracheostomy (odds ratio [OR] = 1.2; 95% CI, 1.1-1.3), which increased among children younger than 2 years old (OR = 1.5; 95% CI, 1.4-1.5). Black children with tracheostomies were also more likely to be diagnosed with laryngeal stenosis and bronchopulmonary dysplasia and to have an extended length of stay ( P < .001). Conclusion Black children are 1.2 times more likely to undergo tracheostomy in the United States compared with other children. Further investigation is warranted to evaluate if there are underlying anatomical, environmental, or psychosocial factors that contribute to this discrepancy.

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Section: Resultscontrasting

confidence: 58%

Section: Discussioncontrasting

confidence: 50%

The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Brown

Shah

Mitchell

et al. 2020

Otolaryngol.--head neck surg.

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“…Early curative surgery may also avoid unnecessary procedures later on. In the context of RS, tracheostomy avoidance is not insignificant and can drastically reduce patient morbidity (Mahida et al, 2016) and health-care costs (Runyan et al, 2014). With appropriate experience and patient selection, we propose that MDO should not be delayed on account of neonatal status alone.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Lee

Eisig

Chuang

et al. 2019

The Cleft Palate Craniofacial Journal

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Objective: The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden. Materials and Methods: This was a retrospective cohort study of the Kids’ Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome. Results: The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures. Conclusions: Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.

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“…Tracheostomy is a common decision parents of critically ill children are asked to consider. The incidence of tracheostomy placement in the United States is increasing, with nearly 5,000 pediatric tracheostomies placed annually (1). The decision to pursue tracheostomy is not one to be taken lightly.…”

Section: Introductionmentioning

confidence: 99%

Parental Conflict, Regret, and Short-term Impact on Quality of Life in Tracheostomy Decision-Making

October

Jones

Michals

et al. 2020

Pediatric Critical Care Medicine

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Objective-The incidence of tracheostomy-dependence in critically ill children is increasing in the US. We do not know the impact of this decision on parental outcomes. We aimed to determine the incidence of decisional conflict and regret and explore the impact on quality of life (QoL) among parents considering tracheostomy placement for their child. Design-prospective, mixed-methods longitudinal studySetting-Pediatric, cardiac, and neonatal intensive care units of a single quaternary medical center. Interventions-none.Measurements and Main Results-Parents completed a Decisional Conflict survey at the time of tracheostomy decision and Decisional Regret and quality of life surveys at two weeks and three months after the decision regarding tracheostomy placement was made. We enrolled 39 parents, of which 25 completed surveys at all three time points. Thirty five of 39 (89.7%) reported at least some decisional conflict, most commonly from feeling uninformed and pressured to make a decision. At two weeks, 13/25 (52%) parents reported regret, which increased to 18/25 participants (72%) at 3-months. Regret stemmed from feeling uninformed, ill-chosen timing of placement and perceptions of inadequate medical care. At two weeks the QoL score was in the

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Tracheostomy Placement in Children Younger Than 2 Years

Cited by 90 publications

References 26 publications

The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

The Incidence of Pediatric Tracheostomy and Its Association Among Black Children

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Parental Conflict, Regret, and Short-term Impact on Quality of Life in Tracheostomy Decision-Making

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