Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia
Objective The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD. Study Design We retrospectively rev...
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| Veröffentlicht in: | Pediatric pulmonology 2021-08, Vol.56 (8), p.2589-2596 |
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| container_title | Pediatric pulmonology |
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| creator | House, Melissa Nathan, Amy Bhuiyan, Mohammad A. N. Ahlfeld, Shawn K. |
| description | Objective
The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.
Study Design
We retrospectively reviewed a single‐center 4‐year cohort of all infants born |
| doi_str_mv | 10.1002/ppul.25455 |
| format | Article |
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The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.
Study Design
We retrospectively reviewed a single‐center 4‐year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post‐discharge respiratory outcomes, and survival were examined up to at least 5 years of age.
Results
At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty‐six infants (94%) had long‐term follow‐up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow‐up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction.
Conclusion
Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.</description><identifier>ISSN: 8755-6863</identifier><identifier>EISSN: 1099-0496</identifier><identifier>DOI: 10.1002/ppul.25455</identifier><identifier>PMID: 34002957</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>bronchopulmonary dysplasia ; chronic lung disease ; Gestational age ; Lung diseases ; Mortality ; Newborn babies ; Ostomy ; prematurity ; Pulmonary hypertension ; tracheostomy ; Tracheotomy</subject><ispartof>Pediatric pulmonology, 2021-08, Vol.56 (8), p.2589-2596</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3575-2fbd0b9443fe36dac256392085f80ad4a8080ea9663b62f3cb61894db1e3ba223</citedby><cites>FETCH-LOGICAL-c3575-2fbd0b9443fe36dac256392085f80ad4a8080ea9663b62f3cb61894db1e3ba223</cites><orcidid>0000-0002-6561-5896</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fppul.25455$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fppul.25455$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34002957$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>House, Melissa</creatorcontrib><creatorcontrib>Nathan, Amy</creatorcontrib><creatorcontrib>Bhuiyan, Mohammad A. N.</creatorcontrib><creatorcontrib>Ahlfeld, Shawn K.</creatorcontrib><title>Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia</title><title>Pediatric pulmonology</title><addtitle>Pediatr Pulmonol</addtitle><description>Objective
The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.
Study Design
We retrospectively reviewed a single‐center 4‐year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post‐discharge respiratory outcomes, and survival were examined up to at least 5 years of age.
Results
At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty‐six infants (94%) had long‐term follow‐up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow‐up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction.
Conclusion
Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.</description><subject>bronchopulmonary dysplasia</subject><subject>chronic lung disease</subject><subject>Gestational age</subject><subject>Lung diseases</subject><subject>Mortality</subject><subject>Newborn babies</subject><subject>Ostomy</subject><subject>prematurity</subject><subject>Pulmonary hypertension</subject><subject>tracheostomy</subject><subject>Tracheotomy</subject><issn>8755-6863</issn><issn>1099-0496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc9LwzAUx4Mobk4v_gES8CJCZ340WXKU4S-YuIM7l6RNXUbb1KRV-t-buenBg_DgHd4nH97LF4BzjKYYIXLTtn01JSxl7ACMMZIyQankh2AsZowlXHA6AichbBCKM4mPwYim8Z1kszHYPDuvbWG7AaqmgN6E1nrVOT9A13e5q02AtolVqqYLcf7eW2-bN9h5la-NC52rB1g6D4P5MN5A7V2Tr11cqXaNippiCG2lglWn4KhUVTBn-z4Bq_u71_ljsnh5eJrfLpKcshlLSKkLpGWa0tJQXqicME4lQYKVAqkiVQIJZJTknGpOSpprjoVMC40N1YoQOgFXO2_r3XtvQpfVNuSmqlRjXB8ywogQhEiOInr5B9243jdxu0gxKqikXETqekfl3oXgTZm13tbxtgyjbJtAtk0g-04gwhd7Za9rU_yiP18eAbwDPm1lhn9U2XK5WuykXwtZk2M</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>House, Melissa</creator><creator>Nathan, Amy</creator><creator>Bhuiyan, Mohammad A. N.</creator><creator>Ahlfeld, Shawn K.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6561-5896</orcidid></search><sort><creationdate>202108</creationdate><title>Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia</title><author>House, Melissa ; Nathan, Amy ; Bhuiyan, Mohammad A. N. ; Ahlfeld, Shawn K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3575-2fbd0b9443fe36dac256392085f80ad4a8080ea9663b62f3cb61894db1e3ba223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>bronchopulmonary dysplasia</topic><topic>chronic lung disease</topic><topic>Gestational age</topic><topic>Lung diseases</topic><topic>Mortality</topic><topic>Newborn babies</topic><topic>Ostomy</topic><topic>prematurity</topic><topic>Pulmonary hypertension</topic><topic>tracheostomy</topic><topic>Tracheotomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>House, Melissa</creatorcontrib><creatorcontrib>Nathan, Amy</creatorcontrib><creatorcontrib>Bhuiyan, Mohammad A. N.</creatorcontrib><creatorcontrib>Ahlfeld, Shawn K.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric pulmonology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>House, Melissa</au><au>Nathan, Amy</au><au>Bhuiyan, Mohammad A. N.</au><au>Ahlfeld, Shawn K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia</atitle><jtitle>Pediatric pulmonology</jtitle><addtitle>Pediatr Pulmonol</addtitle><date>2021-08</date><risdate>2021</risdate><volume>56</volume><issue>8</issue><spage>2589</spage><epage>2596</epage><pages>2589-2596</pages><issn>8755-6863</issn><eissn>1099-0496</eissn><abstract>Objective
The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.
Study Design
We retrospectively reviewed a single‐center 4‐year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post‐discharge respiratory outcomes, and survival were examined up to at least 5 years of age.
Results
At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty‐six infants (94%) had long‐term follow‐up. Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow‐up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction.
Conclusion
Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34002957</pmid><doi>10.1002/ppul.25455</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6561-5896</orcidid></addata></record> |
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| subjects | bronchopulmonary dysplasia chronic lung disease Gestational age Lung diseases Mortality Newborn babies Ostomy prematurity Pulmonary hypertension tracheostomy Tracheotomy |
| title | Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia |
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