Tracheostomy in the extremely premature neonate - Long term outcomes in a multi-institutional study

Taylor B. Teplitzky, Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, University of Maryland Children's Hospital, Baltimore, MD, USA.
Jerrah C. Pickle, Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, University of Maryland Children's Hospital, Baltimore, MD, USA.
Julianna L. DeCuzzi, Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, University of Maryland Children's Hospital, Baltimore, MD, USA.
Karen B. Zur, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Terri Giordano, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Diego A. Preciado, Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA.
Prashant Saini, Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA.
Jenna W. Briddell, Division of Otolaryngology, Nemours/A. I. DuPont Hospital for Children, Wilmington, DE, USA; Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.
Amal Isaiah, Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, University of Maryland Children's Hospital, Baltimore, MD, USA.
Kevin D. Pereira, Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, University of Maryland Children's Hospital, Baltimore, MD, USA. Electronic address: kpereira@som.umaryland.edu.

Document Type

Journal Article

Publication Date

2-22-2023

Journal

International journal of pediatric otorhinolaryngology

Volume

167

DOI

10.1016/j.ijporl.2023.111492

Keywords

Extreme prematurity; Neonatal airway; Neonatal tracheostomy; Pediatric tracheostomy

Abstract

OBJECTIVES: To describe the long-term outcomes related to breathing, feeding, and neurocognitive development in extremely premature infants requiring tracheostomy. STUDY DESIGN: Pooled cross-sectional survey. SETTING: Multi-institutional academic children's hospitals. METHODS: Extremely premature infants who underwent tracheostomy between January 1, 2012, and December 31, 2019, at four academic hospitals were identified from an existing database. Information was gathered from responses to a questionnaire by caregivers regarding airway status, feeding, and neurodevelopment 2-9 years after tracheostomy. RESULTS: Data was available for 89/91 children (96.8%). The mean gestational age was 25.5 weeks (95% CI 25.2-25.7) and mean birth weight was 0.71 kg (95% CI 0.67-0.75). Mean post gestational age at tracheostomy was 22.8 weeks (95% CI 19.0-26.6). At time of the survey, 18 (20.2%) were deceased. 29 (40.8%) maintained a tracheostomy, 18 (25.4%) were on ventilatory support, and 5 (7%) required 24-h supplemental oxygen. Forty-six (64.8%) maintained a gastrostomy tube, 25 (35.2%) had oral dysphagia, and 24 (33.8%) required a modified diet. 51 (71.8%) had developmental delay, 45 (63.4%) were enrolled in school of whom 33 (73.3%) required special education services. CONCLUSIONS: Tracheostomy in extremely premature neonates is associated with long term morbidity in the pulmonary, feeding, and neurocognitive domains. At time of the survey, about half are decannulated, with a majority weaned off ventilatory support indicating improvement in lung function with age. Feeding dysfunction is persistent, and a significant number will have some degree of neurocognitive dysfunction at school age. This information may help caregivers regarding expectations and plans for resource management.

Department

Surgery

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