Current Trends in Neonatal Tracheostomy.

MedStar author(s):
Citation: JAMA Otolaryngology-- Head & Neck Surgery. 142(8):738-42, 2016 Aug 01PMID: 27281282Institution: MedStar Washington Hospital CenterDepartment: OtolaryngologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Tracheostomy/sn [Statistics & Numerical Data] | Airway Obstruction/th [Therapy] | Birth Weight | Craniofacial Abnormalities/th [Therapy] | Female | Humans | Infant | Infant, Newborn | Laryngostenosis/th [Therapy] | Male | Respiratory Insufficiency/th [Therapy] | Retrospective StudiesYear: 2016ISSN:
  • 2168-6181
Name of journal: JAMA otolaryngology-- head & neck surgeryAbstract: 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.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.IMPORTANCE: The indications for neonatal tracheostomy may have changed with current noninvasive respiratory therapies compared with previous decades.MAIN OUTCOMES AND MEASURES: Differences in gestational age, birth weight, and age at tracheostomy.OBJECTIVES: To study the current trends in neonatal tracheostomy and identify the primary indication for the procedure and risk factors for failed extubation.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.All authors: Isaiah A, Moyer K, Pereira KDFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-24
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Journal Article MedStar Authors Catalog Article 27281282 Available 27281282

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.

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.

IMPORTANCE: The indications for neonatal tracheostomy may have changed with current noninvasive respiratory therapies compared with previous decades.

MAIN OUTCOMES AND MEASURES: Differences in gestational age, birth weight, and age at tracheostomy.

OBJECTIVES: To study the current trends in neonatal tracheostomy and identify the primary indication for the procedure and risk factors for failed extubation.

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.

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