Related Experiment Video
Updated: Dec 10, 2025
Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications
Published on: March 15, 2024
Outcomes of neonates with tracheostomy secondary to bronchopulmonary dysplasia
Kirtikumar Upadhyay1,2, Dario Antonio Vallarino3, Ajay J Talati4,5
1Division of Neonatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, 853 Jefferson Avenue, Suite E#201, Memphis, TN, 38103, USA.
Insights
Outcomes for preterm infants with severe bronchopulmonary dysplasia (BPD) requiring tracheostomy show high survival to discharge but significant long-term morbidity. Later postmenstrual age at NICU admission and small for gestational age are linked to worse outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm neonates.
- Severe BPD can lead to pulmonary hypertension and the need for mechanical ventilation via tracheostomy.
- Outcomes for these vulnerable infants are not well-documented.
Purpose of the Study:
- To review the survival and outcomes of preterm neonates requiring tracheostomy due to severe BPD.
- To assess outcomes at 24 months of age in a cohort of infants with BPD requiring tracheostomy.
Main Methods:
- Retrospective chart review of infants diagnosed with BPD and undergoing tracheostomy.
- Data collected from January 2011 to May 2016 at a children's hospital NICU.
- Included data from hospital stay and follow-up clinics.
Main Results:
- 83% of 41 identified infants survived to NICU discharge.
- 66% experienced a composite outcome of death, ventilator dependency, or poor neurodevelopmental outcome at 2 years.
- Higher respiratory severity score, later post-menstrual age at NICU admission, and being small for gestational age were associated with worse outcomes.
Conclusions:
- Neonates with severe BPD requiring tracheostomy have high survival rates to discharge but face substantial long-term morbidity.
- Prolonged home ventilation is common among survivors.
- Later post-menstrual age at NICU admission and small for gestational age are predictors of worse outcomes, highlighting the need for specialized care.
Background:
Bronchopulmonary dysplasia (BPD) is a disease that can affect preterm neonates. Infants with severe BPD may develop pulmonary hypertension (PHN) and may require chronic mechanical ventilation with tracheostomy. The outcomes of these infants have not been studied well. We proposed to review survival and outcomes of infants requiring tracheostomy secondary to severe BPD in our NICU at 24 months.
Methods:
We reviewed infants' charts who were diagnosed with BPD that underwent tracheostomy from January 2011 to May 2016 at our children's hospital NICU. Data were recorded from hospital stay as well as from follow up clinics. Institutional review board approval was obtained prior to beginning of study.
Results:
Forty-one babies (37 during initial hospitalization and 4 subsequently) requiring tracheostomy were identified from our database. Median gestational age at birth was 26 weeks (25-27 IQR), mean birthweight of 731 g (±245 SD) and 32% were small for gestational age (SGA). Median age of tracheostomy placement was 168 days (108-197 IQR), and median PMA 48 wks (40-56 IQR). 26% of infants requiring tracheostomy also had subglottic stenosis along with BPD. 34 infants (83%) survived to discharge from NICU. 66% (27/41) of our patients had a composite outcome of death, ventilator dependency and/or poor neurodevelopmental outcome at 2 years. We found that a higher respiratory severity score at the time of tracheostomy placement and later post-menstrual age at admission to level IV NICU was associated with a worse outcome. Small for gestational age infants were found to have worse outcomes as well. 41% (13/32) of infants had more than 3 hospital admissions after discharge.
Conclusions:
In our cohort about 80% of infants with severe BPD and tracheostomy survived to discharge with need for prolonged home ventilation in more than half of the survivors. Later postmenstrual age at admission to level 4 NICU was associated with a worse outcome. Our retrospective data may be inadequate to determine the causal relationship between postmenstrual age at admission and outcome. These patients continue to have high morbidity and recurrent hospitalizations.
Related Concept Videos
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...