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. 2020 Aug;130(8):2056-2062.
doi: 10.1002/lary.28304. Epub 2019 Sep 18.

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis

Cynthia S Wang  1 , Yann-Fuu Kou  1 , Gopi B Shah  1   2 , Ron B Mitchell  1   2 , Romaine F Johnson  1   2
Affiliations

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis

Cynthia S Wang et al. Laryngoscope. 2020 Aug.

Abstract

Objectives/hypothesis: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased.

Study design: Retrospective cross-sectional analysis.

Methods: We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD.

Results: The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002).

Conclusions: Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis.

Level of evidence: 4 Laryngoscope, 130: 2056-2062, 2020.

Keywords: Tracheostomy; bronchopulmonary dysplasia; premature neonate; preterm neonate.

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References

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