title: High surgical burden for infants with severe chronic lung disease (sCLD).
abstract: OBJECTIVE
  Infants with severe chronic lung disease (sCLD) may require surgical procedures to manage their medical problems; however, the scope of these interventions is undefined. The purpose of this study was to characterize the frequency, type, and timing of operative interventions performed in hospitalized infants with sCLD.
  
  
  METHODS
  The Children's Hospital Neonatal Database was used to identify infants with sCLD from 24 children's hospital's NICUs hospitalized over a recent 16-month period.
  
  
  RESULTS
  556 infants were diagnosed with sCLD; less than 3% of infants had operations prior to referral and 30% were referred for surgical evaluation. In contrast, 71% of all sCLD infants received ≥1 surgical procedure during the CHND NICU hospitalization, with a mean of 3 operations performed per infant. Gastrostomy insertion (24%), fundoplication (11%), herniorrhaphy (13%), and tracheostomy placement (12%) were the most commonly performed operations. The timing of gastrostomy (PMA 48±10 wk) and tracheostomy (PMA 47±7 wk) insertions varied, and for infants who received both devices, only 33% were inserted concurrently (13/40 infants).
  
  
  CONCLUSIONS
  A striking majority of infants with sCLD received multiple surgical procedures during hospitalizations at participating NICUs. Further work regarding the timing, coordination, perioperative complications, and clinical outcomes for these infants is warranted.
authors.affiliation: University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO. Electronic address: theresa.grover@childrenscolorado.org.
authors.forename: Theresa R
authors.initials: TR
authors.lastname: Grover
authors.affiliation: University of Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Brozanski
authors.affiliation: University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
authors.forename: James
authors.initials: J
authors.lastname: Barry
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Hospital Oakland & Research Center, Oakland, CA.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Children's Hospital Oakland & Research Center, Oakland, CA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: George Washington University School of Medicine and Children's National Medical Center, Washington, DC.
authors.forename: Billie L
authors.initials: BL
authors.lastname: Short
authors.affiliation: University of Missouri School of Medicine and Children's Mercy Hospital, Kansas City, MO.
authors.forename: Eugenia K
authors.initials: EK
authors.lastname: Pallotto
authors.affiliation: Emory University School of Medicine, Atlanta, GA.
authors.forename: Francine
authors.initials: F
authors.lastname: Dykes
authors.affiliation: Ohio State University School of Medicine and Nationwide Children's Hospital, Columbus, OH.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Reber
authors.affiliation: Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Padula
authors.affiliation: Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Jacquelyn R
authors.initials: JR
authors.lastname: Evans
authors.affiliation: Feinberg School of Medicine, Northwestern University & the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Karna
authors.initials: K
authors.lastname: Murthy
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000601:surgery*; D007363:Intensive Care Units, Neonatal; D008171:Lung Diseases / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Bronchopulmonary dysplasia (BPD); Chronic lung disease (CLD); Neonatal surgery; Tracheostomy