Guirguis Fady, Chorney Stephen R, Wang Cynthia, Lenes-Voit Felicity, Shah Gopi B, Mitchell Ron B, Johnson Romaine F
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Health Airway Management Program (CHAMP), Children's Medical Center Dallas, Dallas, TX, USA.
Int J Pediatr Otorhinolaryngol. 2022 Jan;152:110985. doi: 10.1016/j.ijporl.2021.110985. Epub 2021 Nov 15.
To describe characteristics and outcomes of infants admitted as neonates requiring tracheostomy placement.
A cross-sectional analysis of the Kids' Inpatient Database (KID) between 2003 and 2016 included all children admitted within the first 28 days of life that had a tracheostomy placed prior to discharge. Patient characteristics and surgical outcomes were compared between term (≥37 weeks gestation) and preterm (<37 weeks gestation) infants. A subset analysis for Black or African American neonates was performed given disproportional preterm births.
An estimated 4268 (95% CI: 4123-4414) tracheostomies were performed in infants admitted as a neonate with preterm infants accounting for 47% (1998/4268). Among preterm children, 20% were Black or African American compared to 12% in the term group (P < .001). More preterm infants had bronchopulmonary dysplasia (46% vs. 14%, P < .001), cardiac defects (66% vs. 58%, P < .001) and developed pneumonia, newborn sepsis, or sepsis during admissions (P < .001). Laryngotracheal anomalies (25% vs. 18%, P < .001) and vocal cord paralysis (11% vs. 4.9%, P < .001) were more common in term infants. Median length of stay (LOS) (154 vs. 100 days, P < .001) and total charges ($1,395,106 vs. $917,478, P < .001) were greater among preterm infants. Mortality was no different between groups (13% vs. 15%, P = .07). Characteristics strongly associated with preterm status were newborn sepsis (OR: 2.31, 95% CI: 1.97-2.72, P < .001), bronchopulmonary dysplasia (OR: 2.17, 95% CI: 1.77-2.65, P < .001) and Black or African American race (OR: 1.78, 95% CI: 1.46-2.17, P < .001). The following factors increased among all neonates between the baseline year 2003 to the final study year 2016: complications of care (OR: 1.9, 95% CI: 1.5-2.5, P < .001); sepsis (OR: 4.1, 95% CI: 3.0-5.5, P < .001); congenital cardiac anomalies (OR: 5.8, 95% CI: 4.5-7.4, P < .001); and respiratory failure (OR: 1.9, 95% CI: 1.5-2.4, P < .001). Compared to other races, median LOS and total charges were greater among Black or African American infants.
Tracheostomies among preterm infants admitted as neonates reflect a growing and complex group with increased costs and hospitalization lengths. Black or African American children are disproportionately born preterm with higher costs and LOS compared to other racial cohorts. Future work will be necessary to design quality-improvement initiatives to improve outcomes for this vulnerable population.
描述新生儿期需行气管造口术的婴儿的特征及预后。
对2003年至2016年儿童住院数据库（KID）进行横断面分析，纳入所有出生后28天内入院且在出院前接受气管造口术的儿童。比较足月儿（≥37周妊娠）和早产儿（<37周妊娠）的患者特征及手术预后。鉴于早产比例不均衡，对黑人或非裔美国新生儿进行了亚组分析。
估计有4268例（95%CI：4123 - 4414）新生儿期入院的婴儿接受了气管造口术，其中早产儿占47%（1998/4268）。在早产儿中，20%为黑人或非裔美国人，而足月儿组这一比例为12%（P <.001）。更多早产儿患有支气管肺发育不良（46%对14%，P <.001）、心脏缺陷（66%对58%，P <.001），且在住院期间发生肺炎、新生儿败血症或败血症（P <.001）。喉气管异常（25%对18%，P <.001）和声带麻痹（11%对4.9%，P <.001）在足月儿中更常见。早产儿的中位住院时间（LOS）（154天对100天，P <.001）和总费用（1,395,106美元对917,478美元，P <.001）更高。两组间死亡率无差异（13%对15%，P =.07）。与早产状态密切相关的特征包括新生儿败血症（OR：2.31，95%CI：1.97 - 2.72，P <.001）、支气管肺发育不良（OR：2.17，95%CI：1.77 - 2.65，P <.001）以及黑人或非裔美国人种族（OR：1.78，95%CI：1.46 - 2.17，P <.001）。从基线年份2003年到最终研究年份2016年，所有新生儿中以下因素有所增加：护理并发症（OR：1.9，95%CI：1.5 - 2.5，P <.001）；败血症（OR：4.1，95%CI：3.0 - 5.5，P <.001）；先天性心脏异常（OR：5.8，95%CI：4.5 - 7.4，P <.001）；以及呼吸衰竭（OR：1.9，95%CI：1.5 - 2.4，P <.001）。与其他种族相比，黑人或非裔美国婴儿的中位住院时间和总费用更高。
新生儿期入院的早产儿接受气管造口术反映了一个不断增长且复杂的群体，其费用和住院时间增加。与其他种族队列相比，黑人或非裔美国儿童早产比例过高，费用和住院时间更长。未来有必要开展质量改进举措，以改善这一弱势群体的预后。
