Tracheotomy in very low birth weight neonates: indications and outcomes. Laryngoscope 2006 Jun;116(6):928-33
Date
06/01/2006Pubmed ID
16735883DOI
10.1097/01.MLG.0000214897.08822.14Scopus ID
2-s2.0-33745282117 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
OBJECTIVE/HYPOTHESIS: To review incidence of, indications for, and outcomes of tracheotomy in very low birth weight (VLBW) infants.
STUDY DESIGN: Retrospective review in tertiary care hospital.
METHODS: Eighteen VLBW (<1,500 g) infants with bronchopulmonary dysplasia undergoing tracheotomy in the neonatal intensive care unit between October 1997 and June 2002 were studied. Controls consisted of 36 VLBW infants undergoing intubation without tracheotomy, two per study infant, matched by gestational age and weight. Outcome measures included duration and number of intubation events, time to decannulation, complications, comorbidities, length of stay, and speech, language, and swallowing measures.
RESULTS: Infants undergoing tracheotomy had an average duration of intubation of 128.8 days with a median number of 11.5 intubation events, both significantly greater than those of controls. Percentage of those with laryngotracheal stenosis was 44% of study infants had laryngotracheal stenosis compared to 1.6% in all intubated VLBW infants. The tracheotomy group had a significantly higher incidence of gastroesophageal reflux, pulmonary hypertension, and gastrostomy tube placement. The overall tracheotomy-related complication rate was 38.9%. Three were lost to follow-up, and five deaths occurred, two possibly tracheotomy-related. Six of ten were decannulated by an average time of 3.8 years, two of six after laryngotracheal reconstruction. Four of ten remained cannulated for a variety of reasons. Disorders of speech, language, and swallowing were common.
CONCLUSIONS: When considering tracheotomy in VLBW infants, the total number of intubation events should be monitored as well as the total duration of intubation. The relatively high incidence of laryngotracheal stenosis argues for earlier endoscopy and possibly earlier tracheotomy in infants with developing stenoses.
Author List
Sisk EA, Kim TB, Schumacher R, Dechert R, Driver L, Ramsey AM, Lesperance MMAuthor
Elizabeth A. Sisk MD Adjunct Assistant Professor in the Otolaryngology and Communication Sciences department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Bronchopulmonary DysplasiaGastroesophageal Reflux
Humans
Infant, Newborn
Infant, Very Low Birth Weight
Intubation, Intratracheal
Laryngostenosis
Postoperative Complications
Retrospective Studies
Tracheal Stenosis
Tracheotomy
Treatment Outcome
