Clinical course following tracheostomy in infancy

Background: Tracheostomy in infants is primarily required for long-term ventilatory support due to lung disease or neuromuscular weakness, and/or to bypass severe upper airway obstruction. Objective: To determine whether the course of respiratory disease changes after tracheostomy, depending on the primary indication for the procedure. Methods: Retrospective review of electronic medical records of infants who underwent tracheostomy. Clinical variables included among others demographics, perinatal history, age at tracheostomy and length of hospital stay. Results: Forty-six infants (29 male) underwent tracheostomy; 30 for ventilatory support (group A) and 16 due to upper airway obstruction (group B). Mean gestational age and birth weight were significantly lower in group A (29±6 vs. 35±6 weeks, p<0.05, 1379±984 vs. 2435±1117 g, p<0.05) while mean age at tracheostomy and length of hospital stay were significantly shorter in group B (135±86 vs. 66±57 days of age, p<0.05 and 217±147 vs. 58±70 days of hospital stay, p<0.05, respectively). There were no statistical differences in emergency room (ER) visits or hospital readmissions. Infants born extremely preterm had increased odds of ER visits in both groups (OR 0.26, p<0.05). Median FiO2 decreased in the weeks after tracheostomy in group A, but not in group B. Number of physical and occupational therapy sessions increased significantly after tracheostomy in both groups (mean 1.06±1.5 vs. 2.9±2.7, p<0.05). Conclusions: Infants who undergo tracheostomy represent two distinct populations. The clinical course after tracheostomy appears to be determined primarily by the underlying condition, especially prematurity and severe BPD. However, tracheostomy appears to facilitate patients’ rehabilitation.