Tracheostomy trends in preterm infants with bronchopulmonary dysplasia in the United States: 2008–2017

Abstract

Objective To determine the trends in tracheostomy placement and resource use in preterm infants less than or equal to 30 weeks gestational age (GA) with bronchopulmonary dysplasia (BPD) in the United States from 2008 to 2017. Study design This was a retrospective, serial cross‐sectional study using data from the NIS. Inclusion criteria were: GA less than or equal to 30 weeks, hospitalization at less than or equal to 28 days of age, assignment of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9‐CM) or ICD10‐CM codes for BPD and tracheostomy. Trends in tracheostomy and resource utilization were assessed using Jonckheere–Terpstra test. p‐value < .05 was considered significant. Results Overall, 987 out of 68,953 (1.4%) hospitalizations with BPD had tracheostomy. Characteristics of the study population: 60.8% were male, 68.4% less than or equal to 26 weeks GA, 43.8% White, 60.5% with Medicaid or self‐pay, 65.2% in the Midwest and South census regions of the United States, and 45.7% had gastrostomy tube placement. Tracheostomy placement (expressed as per 100,000 live births) decreased from 2.7 in 2008 to 1.9 in 2011. Thereafter, it increased from 1.9 in 2011 to 3.5 in 2017 (p < .001). GA less than or equal to 24 weeks was significantly associated with increased odds of tracheostomy placement. Median length of stay increased significantly from 170 to 231 days while median inflation adjusted hospital cost increased significantly from $323,091 in 2008–2009 to $687,141 between 2008–2009 and 2016–2017. Conclusion Although tracheostomy placement among preterm hospitalizations with BPD was rare, the frequency of its placement and its associated resource utilization significantly increased during the study period. Future studies should probe the reasons and factors behind these trends.

Tracheostomy in infants with severe bronchopulmonary dysplasia: A review

“…Prolonged mechanical ventilation in post-prematurity infants with severe bronchopulmonary dysplasia (BPD) is now the most common indication for tracheostomy in infants ( 5 , 6 ). As advanced technology in neonatal intensive care units (NICUs) becomes more routine, the survival of extremely premature infants has also increased the need for long-term mechanical ventilation ( 7 ), specifically for those infants born at the threshold of viability (≤24 weeks' gestation), who have greater odds of developing severe BPD ( 8 , 9 ). Other reasons for performing tracheostomy in infants include congenital anomalies of the airway, neurological and complex cardiac anomalies, and genetic diseases with either short- or long-term survival outcome ( 7 , 8 , 10 ).…”

“…A recent study found that the rate of tracheostomy in infants increased from 1.9 to 3.5 per 100,000 live births between 2011 and 2017 with a corresponding increase in hospital costs ( 8 ). Murthy et al reported that among members of the Children's Hospital Neonatal Consortium (CHNC), the incidence of tracheostomy varied between centers ranging from as low as 2% to as high as 37%, showing that the indication of tracheostomy in severe BPD infants remains uncertain ( 11 ).…”

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“…More importantly, in vitro data on antifibrotics have not only demonstrated an ability to slow down the initiation and progression of lung fibrosis, including the release of proinflammatory and profibrotic mediators, but also to inhibit the vascular cell proliferation. 59 With the recent approval of antifibrotic medications for fibrosing ILDs such as IPF and SSc-ILD, we may potentially see a decrease in the incidence of PH-ILD and PAH in the future.…”

PH Professional Network: 360-degree Care for the Bronchopulmonary Dysplasia Infant with Pulmonary Hypertension: A Comprehensive Review

“…These infants are overall a small proportion of total BPD patients, but they are a high-risk population with high morbidity and mortality, requires specialized care, and has grown in recent years. 59 An interdisciplinary team including neonatology, otolaryngology, pulmonology, respiratory therapy, and palliative care may be helpful in determining which patients would benefit from tracheostomy placement and best determine the timing for this intervention.…”