Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Critical Care

Background:

• Extremely premature infants (23-28 weeks gestational age) often require advanced respiratory support.
• Tracheostomy is a procedure considered for prolonged mechanical ventilation in neonates.
• Understanding the characteristics and outcomes of tracheostomy in this population is crucial.

Purpose of the Study:

• To characterize infants undergoing tracheostomy at extremely premature gestations.
• To describe the in-hospital morbidity associated with tracheostomy in this cohort.
• To assess factors influencing outcomes such as mortality and neurodevelopment.

Main Methods:

• Pooled retrospective analysis of 119 infant charts from 4 academic children's hospitals.
• Inclusion criteria: gestational age 23-28 weeks, tracheostomy between 2012-2017.
• Data collected: demographics, procedural complications, feeding, respiratory, and neurodevelopmental outcomes.

Main Results:

• The primary indication for tracheostomy was chronic lung disease (92.4%).
• Most infants (60.5%) experienced at least one complication, most commonly skin breakdown.
• At transfer, 94% remained mechanically ventilated and 90% required feeding tubes.

Conclusions:

• Tracheostomy in extremely premature neonates is predominantly for chronic lung disease.
• Complications are common, highlighting the risks associated with the procedure.
• Tracheostomy placement did not appear to decrease the systemic morbidity linked to extreme prematurity.