Abstract
AIMS: To record and analyse the technical aspects of neonatal tracheostomy and to suggest some solutions.Materials and Methods: This is a retrospective observational cohort of 37 cases of neonatal tracheostomies performed over 30 years (1985-2014).Results: Thirty-three of the 37 tracheostomies were done as an elective procedure and four done emergently. Eighteen neonatal tracheostomies were done with a low transverse cervical incision and 19 were done with low vertical cervical incision. Three patients had bleeding while exposing the trachea. Trachea could not easily be identified in 2 cases. Commercial tracheostomy tubes were used in only 20 cases. In 17 patients, the conventional endotracheal tubes 2.5 or 3fr size were used. There were 3 instances of wound infection out of which one has peri-tracheostomy necrotizing cellulitis and the neonate succumbed to sepsis. Two cases had surgical emphysema. No case had pneumothorax.Conclusion: We described tracheostomy in neonates in a resource constrained centre. Various makeshift arrangements can be used in absence of standard supplies.
Highlights
Tracheostomy has been a known emergency airway access for years but neonatal tracheostomy, the art, the science and the skills are slowly vanishing
Thirty-three of the 37 tracheostomies were done as an elective procedure for prolonged ventilation
Of the four done as emergency, 2 neonates had massive intraoral tumors presenting at birth, 1 neonate had severe laryngomalacia and 1 had laryngomalacia induced by cervical lymphangiomatosis
Summary
Thirty-three of the 37 tracheostomies were done as an elective procedure and four done emergently. Eighteen neonatal tracheostomies were done with a low transverse cervical incision and 19 were done with low vertical cervical incision. Three patients had bleeding while exposing the trachea. Trachea could not be identified in 2 cases. Commercial tracheostomy tubes were used in only 20 cases. In 17 patients, the conventional endotracheal tubes 2.5 or 3fr size were used. There were 3 instances of wound infection out of which one has peri-tracheostomy necrotizing cellulitis and the neonate succumbed to sepsis. Conclusion: We described tracheostomy in neonates in a resource constrained centre. Various makeshift arrangements can be used in absence of standard supplies
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