Current trends in neonatal tracheostomy

Abstract

Importance: The indications for neonatal tracheostomymay have changed with current noninvasive respiratory therapies compared with previous decades. Objectives: To study the current trends in neonatal tracheostomy and identify the primary indication for the procedure and risk factors for failed extubation. Design, Setting, and Participants: This retrospective medical record review included 47 neonates who underwent tracheostomy from January 1, 2009, to December 31, 2013, at the University of Maryland Children's Hospital. Group 1 included infants undergoing tracheostomy for the primary indication of upper airway obstruction; group 2, infants with primary pulmonary disease. Data on weight, gestational age, comorbid conditions, congenital abnormalities, complications, outcomes, and indications for tracheostomy were compared statistically between groups. Main Outcomes and Measures: Differences in gestational age, birthweight, and age at tracheostomy. Results: Among the 47 infants included in the study (30 boys; 17 girls, mean [SD] age, 113 [73] days), 31 (66%) demonstrated anatomical causes of airway obstruction, and 16 (34%) had significant pulmonary disease. Among infants with anatomical causes, subglottic stenosis represented the largest group (11 of 31 [35%]). The mean age at the time of tracheostomy was significantly lower in the group with airway obstruction (98.9 vs 146.9 days; difference, 48 [95%CI, 4.8-91.2] days; P = .04). No procedure-related morbidity or mortality was encountered. Conclusions and Relevance: Anatomical upper airway obstruction may be returning as the most common indication for a neonatal tracheostomy, thereby supporting the belief that current respiratory therapies have lowered the burden of chronic lung disease and the need for prolonged ventilatory care.