Sara B DeMauro1, Jo Ann D'Agostino2, Carla Bann3, Judy Bernbaum4, Marsha Gerdes4, Edward F Bell5, Waldemar A Carlo6, Carl T D'Angio3, Abhik Das7, Rosemary Higgins8, Susan R Hintz9, Abbot R Laptook10, Girija Natarajan11, Leif Nelin12, Brenda B Poindexter13, Pablo J Sanchez14, Seetha Shankaran11, Barbara J Stoll15, William Truog16, Krisa P Van Meurs9, Betty Vohr10, Michele C Walsh17, Haresh Kirpalani4. 1. Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA. Electronic address: DeMauro@email.chop.edu. 2. Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 3. Research Triangle Institute, Research Triangle Park, NC. 4. Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA. 5. Department of Pediatrics, University of Iowa, Iowa City, IA. 6. Department of Pediatrics, University of Alabama, Birmingham, AL. 7. Department of Pediatrics, The University of Rochester, Rochester, NY. 8. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, Rockville, MD. 9. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 10. Department of Pediatrics, Brown University, Providence, RI. 11. Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI. 12. Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH. 13. Department of Pediatrics, Indiana University, Indianapolis, IN. 14. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 15. Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA. 16. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 17. Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
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.
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.
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