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Laryngotracheal Reconstruction Outcomes in Children Born Extremely Premature

Daniel Blumenthal1,2, James A Leonard1,2, Andy Habib3

  • 1Department of Pediatric Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.

The Laryngoscope
|April 26, 2023
PubMed

Insights

Extremely premature infants undergoing laryngotracheal reconstruction (LTR) have similar decannulation success rates but face a higher risk of complications. This study highlights increased risks associated with LTR in this vulnerable population.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Neonatal Care

Background:

  • The number of neonates born extremely premature (≤28 weeks gestational age) is increasing.
  • Many extremely premature infants require tracheostomy and laryngotracheal reconstruction (LTR) early in life.
  • Post-surgical outcomes for LTR in extremely premature infants are not well-documented.

Purpose of the Study:

  • To compare decannulation rates, time to decannulation, and complication rates.
  • To evaluate outcomes of LTR in extremely premature infants versus preterm and term infants.

Main Methods:

  • Retrospective review of 179 patients undergoing open airway reconstruction (2008-2021).
  • Statistical analysis included Chi Squared, Mann-Whitney, Kaplan Meier, log-rank, and Cox proportional hazards regression.
  • Comparison of outcomes between extremely premature, preterm, and term infant groups.

Main Results:

  • Extremely premature infants had a higher likelihood of complications post-LTR (OR=2.363, p=0.005).
  • No significant difference was observed in time to decannulation (p=0.0543) or decannulation rate (OR=0.4985, p=0.05).
  • Extremely premature infants were more likely to require anterior/posterior grafts (OR=2.471, p=0.004) and airway stents (OR=3.112, p<0.001).

Conclusions:

  • Extremely premature infants achieve comparable decannulation success after LTR.
  • However, they face a significantly increased risk of post-surgical complications.
  • These findings underscore the need for careful management and monitoring in this patient group.
Abstract

Keywords:
extreme prematuritylaryngotracheal reconstructionprematurity

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