Lee Jan Hau, Smith P Brian, Quek M Bin Huey, Laughon Matthew M, Clark Reese H, Hornik Christoph P
Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; Duke-National University of Singapore School of Medicine, Singapore.
Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
J Pediatr. 2016 Jun;173:39-44.e1. doi: 10.1016/j.jpeds.2016.01.072. Epub 2016 Mar 2.
To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit.
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.
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.
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.
描述新生儿重症监护病房中婴儿气管切开术的流行病学、危险因素及住院期间的转归。
我们分析了1997年至2012年期间348个新生儿重症监护病房的电子病历，评估了婴儿人口统计学、诊断以及气管切开术前心肺支持与住院死亡率之间的关联。我们还确定了婴儿气管切开术随时间的使用趋势。
我们在887910例婴儿中识别出885例（0.1%）接受了气管切开术，这些婴儿出生后中位年龄为72天（四分位间距，27 - 119天），月经龄中位值为42周（四分位间距，39 - 46周）。与气管切开术相关的最常见诊断为支气管肺发育不良（885例中的396例；45%）、其他上气道异常（885例中的202例；23%）和喉部异常（885例中的115例；13%）。气管切开术后的住院死亡率为14%（885例中的125例）。经校正分析，近足月胎龄（GA）、小于胎龄状态、肺部诊断、吸入氧分数>0.4的天数以及气管切开术前的血管活性药物支持与住院死亡率增加相关。需要气管切开术的婴儿比例从1997年的0.01%增加至2005年的0.1%（P < 0.001），但此后一直保持稳定。
住院婴儿中气管切开术并不常见，但相关死亡率很高。气管切开术后住院死亡率增加的危险因素包括近足月GA、小于胎龄状态和肺部诊断。
