Tracheostomy for infants requiring prolonged mechanical ventilation: 10 years' experience

Area of Science:

• Neonatal care
• Pediatric critical care
• Respiratory medicine

Background:

• Extended mechanical ventilation and tracheostomy are sometimes necessary for critically ill neonates.
• Few studies have focused on the long-term outcomes and complications associated with tracheostomy in this population.

Purpose of the Study:

• To investigate the long-term clinical outcomes and complications in a cohort of infants who required tracheostomy and mechanical ventilation.
• To compare outcomes based on birth weight, specifically for extremely low birth weight infants.

Main Methods:

• Retrospective review of 165 infants requiring tracheostomy and ventilator support between 2000 and 2010.
• Exclusion of infants with complex congenital heart disease.
• Stratification into two groups based on birth weight: ≤1000 g and >1000 g.

Main Results:

• Higher tracheostomy rates observed in infants weighing ≤1000 g (6.9%) compared to those >1000 g (0.9%).
• Infants weighing ≤1000 g experienced longer durations to achieve positive pressure ventilation independence.
• High survival rates (89%) were noted, but frequent developmental delays (64.2%) and comorbidities (74.2%) were prevalent, particularly in the lower birth weight group.

Conclusions:

• Tracheostomy rates are higher in extremely low birth weight infants than previously reported.
• Decannulation and laryngotracheal reconstruction rates align with existing literature.
• While survival is high, significant rates of developmental delay and comorbidities necessitate ongoing monitoring and support for these infants.