Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Pediatric Otolaryngology, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A.
Laryngoscope. 2020 Aug;130(8):2056-2062. doi: 10.1002/lary.28304. Epub 2019 Sep 18.
OBJECTIVES/HYPOTHESIS: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased.
Retrospective cross-sectional analysis.
We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD.
The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002).
Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis.
4 Laryngoscope, 130: 2056-2062, 2020.
目的/假设：支气管肺发育不良（BPD）和有创呼吸支持在极早产儿中越来越常见。然而，目前尚不清楚气管切开术是否相应增加。我们假设在患有 BPD 的极早产儿中，气管切开术的发生率有所增加。
回顾性横断面分析。
我们分析了 2006 年至 2012 年的 Kids' Inpatient Databases（KID），以获取无早产（胎龄>28 周且<37 周或出生体重>1,500 克）和极早产（胎龄≤28 周或出生体重≤1,500 克）新生儿的出院记录。我们研究了这两个人群中气管切开术的放置趋势，以了解它们是否在极早产儿中，尤其是在患有 BPD 的极早产儿中增加。
该研究纳入了 1,418,681 名早产儿（52%为男性，50%为白人，19%为黑人，20%为西班牙裔，4.2%为亚洲人），其中 118,676 名（8.4%）为极早产儿。共进行了 2,029 例气管切开术，其中 803 例（0.68%）在极早产儿中进行。患有 BPD 的极早产儿的发生比例从 2006 年到 2012 年增加了 17%，而气管切开术的数量增加了 31%。在所有接受气管切开术的患者中，极早产儿的死亡率高于非极早产儿（18%比 14%，P=0.05）。然而，在极早产儿中，接受气管切开术的患者死亡率低于未接受气管切开术的患者（18%比 24%，P=0.002）。
与非极早产儿相比，极早产儿在 2006 年至 2012 年间进行的气管切开术明显增加，BPD 的发生率也有所增加，证实了我们的主要研究假设。
4 级 Laryngoscope, 130: 2056-2062, 2020.
