Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants.
OBJECTIVE
To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit.


STUDY DESIGN
We analyzed electronic medical records from 348 neonatal intensive care units for the period 1997 to 2012, and evaluated the associations among infant demographics, diagnoses, and pretracheostomy cardiopulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time.


RESULTS
We identified 885 of 887 910 infants (0.1%) who underwent tracheostomy at a median postnatal age of 72 days (IQR, 27-119 days) and a median postmenstrual age of 42 weeks (IQR, 39-46 weeks). The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia (396 of 885; 45%), other upper airway anomalies (202 of 885; 23%), and laryngeal anomalies (115 of 885; 13%). In-hospital mortality after tracheostomy was 14% (125 of 885). On adjusted analysis, near-term gestational age (GA), small for GA status, pulmonary diagnoses, number of days of forced fraction of inspired oxygen >0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P < .001), but has remained stable since.


CONCLUSION
Tracheostomy is not commonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include near-term GA, small for GA status, and pulmonary diagnoses.
['Lee|Jan Hau|JH|', 'Smith|P Brian|PB|', 'Quek|M Bin Huey|MB|', 'Laughon|Matthew M|MM|', 'Clark|Reese H|RH|', 'Hornik|Christoph P|CP|']
D001997:Bronchopulmonary Dysplasia D002316:Cardiotonic Agents D005260:Female D005865:Gestational Age D065630:Hernias, Diaphragmatic, Congenital D017052:Hospital Mortality D006801:Humans D007223:Infant D007231:Infant, Newborn D007236:Infant, Small for Gestational Age D007363:Intensive Care Units, Neonatal D007902:Length of Stay D008168:Lung D008297:Male D010100:Oxygen D012121:Respiration, Artificial D053120:Respiratory Aspiration D012189:Retrospective Studies D012307:Risk Factors D014139:Tracheostomy
tracheostomy infants neonates mortality database mechanical ventilation