Developmental outcomes after tracheostomy in extremely preterm neonates

To evaluate two-year developmental outcomes in children born extremely preterm (<28 weeks) with and without tracheostomy placement.

A case series with chart review included extremely preterm infants at a single neonatal intensive care unit. Children were grouped into obtaining a tracheostomy at less than 12 months or not requiring tracheostomy. All children obtained a two-year Bayley Scales of Infant and Toddler Development, 3rd Edition assessment between 2015 and 2022. Composite scores for cognition, language and motor skills for adjusted age were reported.

Seventy-five children (mean age 2.1 years, standard deviation [SD]: .08) were included, with a mean gestational age of 26.4 weeks (SD: 1.6) and birth weight of 916.9 g (SD: 260.0). Thirteen children (17 %) had a tracheostomy. Compared to those without a tracheostomy, these children had lower gestational age (P = .003), smaller birth weight (P = .002), and higher rates of hearing loss (P = .01). At two-year Bayley testing, children with a tracheostomy had significantly lower cognitive, motor, and language scores (all P < .01) and higher rates of moderate to severe impairment. Regression analysis showed tracheostomy was associated with lower cognitive (β: -19.7, 95 % CI: -26.7 to -12.8, P < .001) and motor scores (β: -26.7, 95 % CI: -34.7 to -18.7, P < .001), while age and newborn hearing screen status influenced language scores.

Tracheostomy-dependent children born extremely preterm have delayed two-year developmental outcomes for their corrected age and benefit from continued monitoring of appropriate childhood milestones.