Optimal timing of gastrostomy tube placement in neonates requiring tracheostomy

To understand characteristics associated with additional operative encounters following tracheostomy to inform the timing of gastrostomy tube (GT) placement in neonates.

Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) and including neonates who underwent tracheostomy with either concurrent or subsequent GT from 1/2015-12/2022. The primary outcome was the number of subsequent operative encounters following tracheostomy. Bivariate analysis and logistic regression assessed for patient characteristics associated with subsequent operative encounters.

Of 2395 neonates, 1693 (71%) underwent concurrent procedures, and 702 (29%) underwent initial tracheostomy alone with subsequent GT (p < 0.001). The median number of operative encounters for the entire cohort following tracheostomy was 3 events (IQR 1-6). Infants with prematurity, cardiac valve malformations, and pulmonary hypertension were more likely to have additional operative encounters.

Neonates born prematurely with cardiovascular comorbidities will likely return to the operating room after tracheostomy placement, presenting an opportunity for GT placement.