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Coordinating Tracheostomy and Gastrostomy in Infants with Bronchopulmonary Dysplasia
Alexander Szymczak1, Ashley Dodd2, Matthew Rowland3,4
1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Concomitant tracheostomy and gastrostomy tube (GT) placement in infants with bronchopulmonary dysplasia (BPD) is feasible and safe. This combined approach is associated with shorter hospital stays and similar complication rates compared to staged procedures.
Area of Science:
- Pediatric surgery
- Neonatology
- Pulmonology
Background:
- Infants with bronchopulmonary dysplasia (BPD) often require both respiratory support (tracheostomy) and enteral feeding access (gastrostomy tube).
- The optimal timing and approach for placing these devices concurrently or sequentially are not well-defined.
Purpose of the Study:
- To identify variables associated with the simultaneous placement of tracheostomy and gastrostomy tubes (GT) in infants with BPD.
- To evaluate the safety and efficacy of concomitant versus staged procedures.
Main Methods:
- Retrospective case-series study of infants (<2 years) who underwent tracheostomy between January 2015 and May 2024 at a tertiary-care children's hospital.
- Data collected included demographic, clinical, and procedural variables.
- Comparison between BPD and non-BPD patients regarding procedure timing and outcomes.
Main Results:
- Of 198 infants, 49 had BPD. Concomitant GT placement occurred in 42.9% of BPD patients.
- A shorter interval (≤30 days) between procedures was more common in BPD patients (22.4% vs 11.4%).
- Concomitant placement was associated with significantly shorter hospital stays (6.41 vs 9.42 months) without increased gastrointestinal complications.
Conclusions:
- Coordinating tracheostomy and GT placement in infants with BPD offers an opportunity to streamline care.
- Concomitant placement is associated with comparable gastrointestinal complication rates and shorter hospital stays.
- A combined surgical approach is supported when feasible for this high-risk population.
Objective:
Patients with bronchopulmonary dysplasia (BPD) often require both invasive respiratory support and durable enteral access. This study aims to identify variables associated with the concomitant placement of tracheostomy and gastrostomy tube (GT) in infants with BPD.
Study Design:
Retrospective case-series study.
Setting:
Tertiary-care children's hospital.
Methods:
Demographic, clinical, and procedural variables were collected from the medical records of infants who underwent tracheostomy at age <2 between 1/2015 and 5/2024.
Results:
Of 198 infants who underwent both tracheostomy and GT placement, 49 (24.7%) had BPD. Among these, median gestational age at birth was 25 weeks [IQR: 3], and age at tracheostomy was 6 months [IQR: 3]. Concomitant GT placement occurred in 21 (42.9%) of BPD patients. A short interval (≤30 days) between procedures was more common in BPD versus non-BPD patients (22.4% vs 11.4%, P < .001). Total time under anesthesia did not differ significantly when procedures were done concomitantly or staged (140 vs 156.5 min, P < .21). Concomitant placement was associated with a significantly shorter hospital stay (6.41 vs 9.42 months, P = .019). No significant differences were found in postoperative ileus, time to full feeds, or socioeconomic factors.
Conclusions:
In infants with BPD, the shorter time interval between tracheostomy and GT placement highlights an opportunity to further streamline care by coordinating these procedures at the same time. Our findings suggest that concomitant tracheostomy and GT placement are associated with comparable gastrointestinal complication rates and shorter hospital stays, supporting a combined surgical approach when feasible in this high-risk population.
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