Developmental outcomes of very preterm infants with tracheostomies.
OBJECTIVE
To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy.


METHODS
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.
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.
Sara B
SB
DeMauro
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Jo Ann
JA
D'Agostino
Research Triangle Institute, Research Triangle Park, NC.
Carla
C
Bann
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA.
Judy
J
Bernbaum
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA.
Marsha
M
Gerdes
Department of Pediatrics, University of Iowa, Iowa City, IA.
Edward F
EF
Bell
Department of Pediatrics, University of Alabama, Birmingham, AL.
Waldemar A
WA
Carlo
Research Triangle Institute, Research Triangle Park, NC.
Carl T
CT
D'Angio
Department of Pediatrics, The University of Rochester, Rochester, NY.
Abhik
A
Das
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, Rockville, MD.
Rosemary
R
Higgins
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Susan R
SR
Hintz
Department of Pediatrics, Brown University, Providence, RI.
Abbot R
AR
Laptook
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Girija
G
Natarajan
Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH.
Leif
L
Nelin
Department of Pediatrics, Indiana University, Indianapolis, IN.
Brenda B
BB
Poindexter
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Pablo J
PJ
Sanchez
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Seetha
S
Shankaran
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
Barbara J
BJ
Stoll
Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
William
W
Truog
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Krisa P
KP
Van Meurs
Department of Pediatrics, Brown University, Providence, RI.
Betty
B
Vohr
Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
Michele C
MC
Walsh
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA.
Haresh
H
Kirpalani
D016022:Case-Control Studies; D002423:Cause of Death; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016001:Confidence Intervals; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016012:Poisson Distribution; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017741:Survivors; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods