Department of Surgery and Center for Advanced Intestinal Rehabilitation, and.
Department of Otolaryngology and Communication Enhancement, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
Pediatrics. 2020 Mar;145(3). doi: 10.1542/peds.2019-2371. Epub 2020 Feb 25.
In this study, we benchmark outcomes and identify factors associated with tracheostomy placement in infants of very low birth weight (VLBW).
Data were prospectively collected on infants of VLBW (401-1500 g or gestational age of 22-29 weeks) born between 2006 and 2016 and admitted to 796 North American centers. Length of stay (LOS), mortality, associated surgical procedures, and comorbidities were assessed, and infants who received tracheostomy were compared with those who did not. Multivariable logistic regressions were performed to identify risk factors for tracheostomy placement and for mortality in those receiving tracheostomy.
Of 458 624 infants of VLBW studied, 3442 (0.75%) received tracheostomy. Infants with tracheostomy had a median (interquartile range) LOS of 226 (168-304) days and a mortality rate of 18.8%, compared with 58 (39-86) days and 8.3% for infants without tracheostomy. Independent risk factors associated with tracheostomy placement included male sex, birth weight <1001 g, African American non-Hispanic maternal race, chronic lung disease (CLD), intraventricular hemorrhage, patent ductus arteriosus ligation, and congenital neurologic, cardiac, and chromosomal anomalies. Among infants who received tracheostomy, male sex, birth weight <751 g, CLD, and congenital anomalies were independent predictors of mortality.
Infants of VLBW receiving tracheostomy had twice the risk of mortality and nearly 4 times the initial LOS of those without tracheostomy. CLD and congenital anomalies were the strongest predictors of tracheostomy placement and mortality. These benchmark data on tracheostomy in infants of VLBW should guide discussions with patient families and inform future studies and interventions.
本研究旨在比较极低出生体重儿（VLBW）的气管切开术结局，并确定影响其结局的相关因素。
本研究前瞻性收集了 2006 年至 2016 年期间在北美 796 家中心出生的 VLBW（401-1500g 或胎龄 22-29 周）婴儿的数据。评估了住院时间（LOS）、死亡率、相关手术和并发症，并比较了接受和未接受气管切开术的婴儿。采用多变量逻辑回归分析确定气管切开术的危险因素以及接受气管切开术婴儿的死亡率相关因素。
在 458624 名 VLBW 婴儿中，3442 名（0.75%）接受了气管切开术。与未行气管切开术的婴儿相比，行气管切开术的婴儿 LOS 中位数（四分位距）为 226（168-304）天，死亡率为 18.8%，而未行气管切开术的婴儿 LOS 中位数（四分位距）为 58（39-86）天，死亡率为 8.3%。与气管切开术相关的独立危险因素包括男性、出生体重<1001g、非裔美国人非西班牙裔母亲种族、慢性肺病（CLD）、脑室出血、动脉导管未闭结扎术以及先天性神经、心脏和染色体异常。在接受气管切开术的婴儿中，男性、出生体重<751g、CLD 和先天性异常是死亡率的独立预测因素。
接受气管切开术的 VLBW 婴儿的死亡率是未接受气管切开术婴儿的两倍，初始 LOS 是未接受气管切开术婴儿的近 4 倍。CLD 和先天性异常是气管切开术和死亡率的最强预测因素。这些 VLBW 婴儿气管切开术的基准数据应指导与患者家属的讨论，并为未来的研究和干预提供信息。
