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Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants

Jan Hau Lee1, P Brian Smith2, M Bin Huey Quek3

  • 1Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; Duke-National University of Singapore School of Medicine, Singapore.

The Journal of Pediatrics
|March 6, 2016
PubMed

Insights

Tracheostomy is uncommon in hospitalized infants but carries a high mortality risk. Factors like near-term gestational age and pulmonary diagnoses increase mortality risk in these infants.

Area of Science:

  • Neonatal intensive care
  • Pediatric surgery
  • Respiratory medicine

Background:

  • Tracheostomy is a critical intervention for infants requiring prolonged mechanical ventilation.
  • Understanding the epidemiology and outcomes of infant tracheostomy is essential for improving care.
  • Data on tracheostomy use and associated mortality in neonatal intensive care units (NICUs) is limited.

Purpose of the Study:

  • To describe the epidemiology of tracheostomy in infants within NICUs.
  • To identify risk factors associated with tracheostomy in this population.
  • To analyze in-hospital outcomes and mortality rates following tracheostomy.

Main Methods:

  • Analysis of electronic medical records from 348 NICUs between 1997 and 2012.
  • Evaluation of infant demographics, diagnoses, and pretracheostomy support.
  • Assessment of trends in infant tracheostomy utilization over time.

Main Results:

  • Tracheostomy was performed in 0.1% of infants, with common diagnoses including bronchopulmonary dysplasia and airway anomalies.
  • In-hospital mortality after tracheostomy was 14%.
  • Increased mortality was linked to near-term gestational age, small for gestational age status, pulmonary diagnoses, oxygen support, and inotropic support.

Conclusions:

  • Tracheostomy is infrequently performed in hospitalized infants but is associated with significant in-hospital mortality.
  • Near-term gestational age, small for gestational age status, and pulmonary diagnoses are key risk factors for mortality.
  • The proportion of infants undergoing tracheostomy increased until 2005 and has since stabilized.
Abstract

Keywords:
databaseinfantsmechanical ventilationmortalityneonatestracheostomy

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