Tracheostomy in the Extremely Premature Neonate: A Multi-Institutional Study.

Autor: Pereira KD; Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA., Shaigany K; Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA., Zur KB; Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Jenks CM; Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Preciado DA; Department of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA., Hamdi O; Howard University College of Medicine, Washington, DC, USA., Banker K; Division of Otolaryngology, Nemours/A. I. DuPont Hospital for Children, Wilmington, Delaware, USA., Briddell JW; Deptartment of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA.; Nemours/A. I. DuPont Hospital for Children, Wilmington, Delaware, USA., Isaiah A; Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2020 Apr; Vol. 162 (4), pp. 559-565. Date of Electronic Publication: 2020 Feb 25.
DOI: 10.1177/0194599820905528
Abstrakt: Objective: (1) To describe characteristics associated with tracheostomy placement and (2) to describe associated in-hospital morbidity in extremely premature infants.
Study Design: Pooled retrospective analysis of charts.
Setting: Academic children's hospitals.
Subjects and Methods: The patient records of premature infants (23-28 weeks gestational age) who underwent tracheostomy between January 1, 2012, and December 31, 2017, were reviewed from 4 academic children's hospitals. Demographics, procedural morbidity, feeding, respiratory, and neurodevelopmental outcomes at the time of transfer from the neonatal intensive care unit (NICU) were obtained. The contribution of baseline characteristics to mortality, neurodevelopmental, and feeding outcomes was also assessed.
Results: The charts of 119 infants were included. The mean gestational age was 25.5 (95% confidence interval, 25.2-25.7) weeks. The mean birth weight was 712 (671-752) g. Approximately 50% was African American. The principal comorbidity was chronic lung disease (92.4%). Overall, 60.5% of the infants had at least 1 complication. At the time of transfer, most remained mechanically ventilated (94%) and dependent on a feeding tube (90%). Necrotizing enterocolitis increased the risk of feeding impairment ( P = .002) and death ( P = .03).
Conclusions: Tracheostomy in the extremely premature neonate is primarily performed for chronic lung disease. Complications occur frequently, with skin breakdown being the most common. Placement of a tracheostomy does not seem to mitigate the systemic morbidity associated with extreme prematurity.
Databáze: MEDLINE
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