Developmental Outcomes of Very Preterm Infants with Tracheostomies

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• 作者：Sara B. DeMauro ; MD ; MSCE¹ ; ² ; ^{DeMauro@email.chop.edu" class="auth_mail} ; Jo Ann D'Agostino ; DNP ; CRNP¹ ; Carla Bann ; PhD³ ; Judy Bernbaum ; MD¹ ; ² ; Marsha Gerdes ; PhD¹ ; ² ; Edward F. Bell ; MD⁴ ; Waldemar A. Carlo ; MD⁵ ; Carl T. D'Angio ; MD³ ; Abhik Das ; PhD⁶ ; Rosemary Higgins ; MD⁷ ; Susan R. Hintz ; MD⁸ ; Abbot R. Laptook ; MD⁹ ; Girija Natarajan ; MD¹⁰ ; Leif Nelin ; MD¹¹ ; Brenda B. Poindexter ; MD¹² ; Pablo J. Sanchez ; MD¹³ ; Seetha Shankaran ; MD¹⁰ ; Barbara J. Stoll ; MD¹⁴ ; William Truog ; MD¹⁵ ; Krisa P. Van Meurs ; MD⁸ ; Betty Vohr ; MD⁹ ; Michele C. Walsh ; MD ; MS¹⁶ ; Haresh Kirpalani ; BM ; MSc¹ ; ² ; on behalf of the Eunice Kennedy Shriver National Institute of Child Health ; Human Development Neonatal Research Network &lowast
• 关键词：Bayley ; Bayley Scales of Infant Development ; BPD ; Bronchopulmonary dysplasia ; IVH ; Intraventricular hemorrhage ; NDI ; Neurodevelopmental impairment ; NEC ; Necrotizing enterocolitis ; NICHD ; Eunice Kennedy Shriver National Institute of Child Health and Human Development ; NRN ; Neonatal Research Network ; ROP ; Retinopathy of prematurity
• 刊名：The Journal of Pediatrics
• 出版年：June 2014
• 年：2014
• 卷：164
• 期：6
• 页码：1303-1310.e2
• 全文大小：293 K

文摘

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

Study design

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.