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Tracheostomy in the extremely premature neonate - Long term outcomes in a multi-institutional study

Taylor B Teplitzky1, Jerrah C Pickle2, Julianna L DeCuzzi2

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, University of Maryland Children's Hospital, Baltimore, MD, USA.

International Journal of Pediatric Otorhinolaryngology
|February 27, 2023
PubMed

Insights

Tracheostomy in extremely premature infants leads to long-term breathing, feeding, and neurocognitive issues. While many improve lung function, persistent feeding difficulties and developmental delays are common.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Developmental Pediatrics

Background:

  • Extremely premature infants often require tracheostomy due to respiratory insufficiency.
  • Long-term outcomes regarding breathing, feeding, and neurodevelopment are critical for this vulnerable population.

Purpose of the Study:

  • To describe the long-term outcomes of breathing, feeding, and neurocognitive development in extremely premature infants who underwent tracheostomy.
  • To provide insights for caregivers regarding expectations and resource management.

Main Methods:

  • A pooled cross-sectional survey was conducted across four academic children's hospitals.
  • Caregiver questionnaires gathered data on airway status, feeding, and neurodevelopment 2-9 years post-tracheostomy for infants born between 2012-2019.

Main Results:

  • Of 89 infants (mean gestational age 25.5 weeks), 20.2% had died by follow-up.
  • 40.8% retained tracheostomy, 25.4% required ventilatory support, and 64.8% needed a gastrostomy tube.
  • 71.8% experienced developmental delay, with 73.3% of those in school requiring special education services.

Conclusions:

  • Tracheostomy in extremely premature neonates is linked to significant long-term pulmonary, feeding, and neurocognitive morbidity.
  • While lung function may improve with age, feeding dysfunction and neurocognitive deficits persist into school age.
  • Findings aid caregivers in setting expectations and planning for ongoing care needs.
Abstract

Keywords:
Extreme prematurityNeonatal airwayNeonatal tracheostomyPediatric tracheostomy

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