A five year retrospective study of short term respiratory support outcomes for infants who received tracheostomy before one year of age

Abstract

ObjectivesThis study aims to describe respiratory support requirements at the time of hospital discharge for infants who undergo tracheostomy, and to determine whether certain indications for tracheostomy are significantly associated with ventilator or oxygen dependence at the time of discharge. MethodsRetrospective chart review identified 150 patients who underwent tracheostomy before 1 year of age at a single center from 2007 to 2012 and were discharged alive. Patients were divided into groups based on primary indication for tracheostomy: chronic lung disease (CLD); cardiac; airway anomalies (e.g., tracheomalacia, subglottic stenosis); anatomic anomalies of head, neck and chest; neuro/muscular; mixed group (>1 primary indication). Chi-squared tests were used to compare respiratory support requirements at time of discharge, as well as need for supplemental oxygen. ResultsOf the 150 patients included in the study, three were discharged on room air alone. Of those 147 who did require some form of support at discharge, significant differences were found between groups when comparing CPAP to ventilator support. For example, of the patients with CLD, 82% were discharged on ventilator support whereas of those with a primary airway indication nearly 54% were discharged on CPAP. Significant differences were also found among groups when comparing patients discharged on room air vs. supplemental oxygen. Patients with CLD were more likely to be discharged on supplemental oxygen (p=0.001) whereas of the patients with anatomic indication 77% required no supplemental oxygen at the time of discharge. ConclusionRespiratory support needs at the time of discharge for neonates who underwent tracheostomy varied significantly depending on the initial indication for tracheostomy. Information about respiratory requirements of infants who undergo tracheostomy can help clinicians counsel families and anticipate post-discharge needs.