title: Tracheostomy for infants requiring prolonged mechanical ventilation: 10 years' experience.
abstract: BACKGROUND
  Despite advances in care of critically ill neonates, extended mechanical ventilation and tracheostomy are sometimes required. Few studies focus on complications and clinical outcomes. Our aim was to provide long-term outcomes for a cohort of infants who required tracheostomy.
  
  
  METHODS
  This study is a retrospective review of 165 infants born between January 1, 2000 and December 31, 2010 who required tracheostomy and ventilator support. Children with complex congenital heart disease were excluded.
  
  
  RESULTS
  Median gestational age was 27 weeks (range 22-43), and birth weight was 820 g (range 360-4860). The number of male (53.9%) and female (46.1%) infants was similar (P = .312). Infants were divided into 2 groups based on birth weight ≤1000 g (A) and >1000 g (B). Group A: 87 (57.6%) infants; group B 64 (42.4%). Overall tracheostomy rate was 6.9% (87/1345) for group A versus 0.9% (64/6818) for B (P <.001). Group A had a longer time from intubation to positive pressure ventilation independence, 505 days (range 62-1287) vs 372 days (range 15-1270; P = .011). Infants who had >1 reason for tracheostomy comprised 78.8% of the sample; 69.1% of infants were discharged on ventilators. Birth weight did not affect time from tracheostomy to decannulation (P = .323). More group A infants were decannulated (P = .023). laryngotracheal reconstruction rate was 35.8%. Five-year survival was 89%. Group B had higher mortality (P = .033). 64.2% of infants had developmental delays; 74.2% had ≥2 comorbidities.
  
  
  CONCLUSIONS
  Tracheostomy rates were higher for extremely low birth weight infants than previously reported rates for all infants. Decannulation rates and laryngotracheal reconstruction rates were consistent with previous studies. Survival rates were high, but developmental delay and comorbidities were frequent.
authors.affiliation: Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Alison E
authors.initials: AE
authors.lastname: Overman
authors.forename: Meixia
authors.initials: M
authors.lastname: Liu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Kurachek
authors.forename: Michael R
authors.initials: MR
authors.lastname: Shreve
authors.forename: Roy C
authors.initials: RC
authors.lastname: Maynard
authors.forename: Mark C
authors.initials: MC
authors.lastname: Mammel
authors.forename: Brooke M
authors.initials: BM
authors.lastname: Moore
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D008910:Minnesota; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: bronchopulmonary dysplasia; infant; prematurity; tracheostomy; ventilator