Developmental outcomes of very preterm infants with tracheostomies

Abstract

Objectives: To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy.

Study design: Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of ≥1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life.

Results: Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9).

Conclusions: Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

Figure. Risk-Adjusted Probabilities of Components of Neurodevelopmental Impairment and Bayley Scales of Infant Development, by Tracheostomy

Error bars represent 95% confidence intervals for risk-adjusted probabilities. Probabilities were adjusted for center, time period, birth weight, sex, antenatal steroid exposure, race, presence of syndromes or major malformations, brain injury, sepsis, NEC, severe ROP, surgical ligation of PDA, BPD (oxygen dependence at 36 weeks) and prolonged ventilation. Language delay is defined as <85 (ie, >1 standard deviation below the expected mean score of 100, on the language scale of the Bayley Scales of Infant Development-III). Neurologic delay is defined as moderate to severe cerebral palsy with GMFCS level of 2 or higher.