Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis

Cynthia S. Wang, Yann Fuu Kou, Gopi B. Shah, Ron B. Mitchell, Romaine F. Johnson

Research output: Contribution to journalArticle

Abstract

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. Study Design: Retrospective cross-sectional analysis. Methods: 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. Results: 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). Conclusions: 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. Level of Evidence: 4 Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Tracheostomy
Cross-Sectional Studies
Newborn Infant
Bronchopulmonary Dysplasia
Gestational Age
Laryngoscopes
Mortality
Incidence
Hispanic Americans
Birth Weight
Inpatients
Retrospective Studies

Keywords

  • bronchopulmonary dysplasia
  • premature neonate
  • preterm neonate
  • Tracheostomy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{eff6041367d34eccab64f7e24e452a64,
title = "Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis",
abstract = "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. Study Design: Retrospective cross-sectional analysis. Methods: 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. Results: 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). Conclusions: 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. Level of Evidence: 4 Laryngoscope, 2019.",
keywords = "bronchopulmonary dysplasia, premature neonate, preterm neonate, Tracheostomy",
author = "Wang, {Cynthia S.} and Kou, {Yann Fuu} and Shah, {Gopi B.} and Mitchell, {Ron B.} and Johnson, {Romaine F.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/lary.28304",
language = "English (US)",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",

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TY - JOUR

T1 - Tracheostomy in Extremely Preterm Neonates in the United States

T2 - A Cross-Sectional Analysis

AU - Wang, Cynthia S.

AU - Kou, Yann Fuu

AU - Shah, Gopi B.

AU - Mitchell, Ron B.

AU - Johnson, Romaine F.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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. Study Design: Retrospective cross-sectional analysis. Methods: 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. Results: 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). Conclusions: 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. Level of Evidence: 4 Laryngoscope, 2019.

AB - 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. Study Design: Retrospective cross-sectional analysis. Methods: 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. Results: 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). Conclusions: 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. Level of Evidence: 4 Laryngoscope, 2019.

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KW - preterm neonate

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