Sharing a new publication about the long-term outcomes for extremely preterm infants (born <28 weeks’ gestation) requiring tracheostomy. The persistent system-wide outcomes are not directly related to the trach but are due to the complex co-morbidities that lead to the need for a trach early in life, in the setting of prematurity.
Teplitzky, T. B., Pickle, J. C., DeCuzzi, J. L., Zur, K. B., Giordano, T., Preciado, D. A., … & Pereira, K. D. (2023). Tracheostomy in the extremely premature neonate–Long term outcomes in a multi-institutional study. International Journal of Pediatric Otorhinolaryngology, 167, 111492.
Methods
Extremely premature infants who underwent tracheostomy between January 1, 2012, and December 31, 2019, at four academic hospitals were identified from an existing database. Information was gathered from responses to a questionnaire by caregivers regarding airway status, feeding, and neurodevelopment 2–9 years after tracheostomy.
Results
Data was available for 89/91 children (96.8%). The mean gestational age was 25.5 weeks (95% CI 25.2–25.7) and mean birth weight was 0.71 kg (95% CI 0.67–0.75). Mean post gestational age at tracheostomy was 22.8 weeks (95% CI 19.0–26.6). At time of the survey, 18 (20.2%) were deceased. 29 (40.8%) maintained a tracheostomy, 18 (25.4%) were on ventilatory support, and 5 (7%) required 24-h supplemental oxygen. Forty-six (64.8%) maintained a gastrostomy tube, 25 (35.2%) had oral dysphagia, and 24 (33.8%) required a modified diet. 51 (71.8%) had developmental delay, 45 (63.4%) were enrolled in school of whom 33 (73.3%) required special education services.
Conclusions
Tracheostomy in extremely premature neonates is associated with long term morbidity in the pulmonary, feeding, and neurocognitive domains. At time of the survey, about half are decannulated, with a majority weaned off ventilatory support indicating improvement in lung function with age. Feeding dysfunction is persistent, and a significant number will have some degree of neurocognitive dysfunction at school age. This information may help caregivers regarding expectations and plans for resource management.