Laryngotracheal Reconstruction Outcomes in Children Born Extremely Premature

Authors

Daniel Blumenthal, Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.
James A. Leonard, Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.
Andy Habib, Georgetown University School of Medicine, Washington, District of Columbia, U.S.A.
Hengameh Behzadpour, Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.
Alexandra Espinel, Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.
Diego Preciado, Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.

Document Type

Journal Article

Publication Date

12-1-2023

Journal

The Laryngoscope

Volume

133

Issue

12

DOI

10.1002/lary.30716

Keywords

extreme prematurity; laryngotracheal reconstruction; prematurity

Abstract

INTRODUCTION: There has been a notable increase in the number of neonates born 28 weeks gestational age or younger in the United States. Many of these patients require tracheostomy early in life and subsequent laryngotracheal reconstruction (LTR). Although extremely premature infants often undergo LTR, there is no known study to date examining their post-surgical outcomes. OBJECTIVES: To compare decannulation rates, time to decannulation and complication rates between LTR patients born extremely premature to those born preterm and term. METHODS: We identified 179 patients treated at a stand-alone tertiary children's hospital who underwent open airway reconstruction from 2008 to 2021. A Chi Squared test was used to detect differences in categorical clinical data between the groups of patients. A Mann-Whitney test was used to analyze continuous data within these same groups. Time to decannulation analysis was performed using Kaplan Meier analysis and evaluated with log-rank and Cox proportional hazards regression. RESULTS: Children born extremely premature were more likely to incur complications following LTR (OR = 2.363, p = 0.005, CI 1.295-4.247). There was no difference in time to decannulation (p = 0.0543, Log-rank) or rate of decannulation (OR = 0.4985, p = 0.05, CI 0.2511-1.008). Extremely premature infants were more likely to be treated with an anterior and posterior grafts (OR = 2.471, p = 0.004, CI 1.297-4.535) and/or an airway stent (OR = 3.112, p < 0.001, CI 1.539-5.987). CONCLUSION: Compared with all other patients, extremely premature infants have equivalent decannulation success, but are at an increased risk for complications following LTR. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:3608-3614, 2023.

APA Citation

Blumenthal, Daniel; Leonard, James A.; Habib, Andy; Behzadpour, Hengameh; Espinel, Alexandra; and Preciado, Diego, "Laryngotracheal Reconstruction Outcomes in Children Born Extremely Premature" (2023). GW Authored Works. Paper 4088.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4088

Department

Surgery