Tracheostomy in Very Low Birth Weight Infants: A Prospective Multicenter Study

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Critical Care

Background:

• Tracheostomy is a critical intervention for infants requiring prolonged mechanical ventilation.
• Very low birth weight (VLBW) infants represent a unique population with specific challenges.
• Understanding factors influencing tracheostomy outcomes in VLBW infants is essential for clinical practice.

Purpose of the Study:

• To benchmark outcomes associated with tracheostomy in VLBW infants.
• To identify independent risk factors for tracheostomy placement in VLBW infants.
• To determine predictors of mortality among VLBW infants who receive tracheostomy.

Main Methods:

• Prospective data collection from 796 North American centers (2006-2016).
• Inclusion of VLBW infants (401-1500 g or 22-29 weeks gestational age).
• Multivariable logistic regression to analyze risk factors for tracheostomy and mortality.

Main Results:

• 0.75% of 458,624 VLBW infants received tracheostomy.
• Tracheostomy associated with increased median length of stay (226 vs. 58 days) and mortality (18.8% vs. 8.3%).
• Independent risk factors for tracheostomy included male sex, low birth weight, African American maternal race, chronic lung disease, intraventricular hemorrhage, PDA ligation, and congenital anomalies.

Conclusions:

• VLBW infants undergoing tracheostomy face doubled mortality risk and quadrupled length of stay.
• Chronic lung disease and congenital anomalies are the strongest predictors for both tracheostomy placement and mortality.
• Benchmark data can inform family discussions, future research, and interventions for VLBW infants requiring tracheostomy.