Developmental outcomes of very preterm infants with tracheostomies

Sara B. Demauro, Jo Ann D'Agostino, Carla Bann, Judy Bernbaum, Marsha Gerdes, Edward F. Bell, Waldemar A. Carlo, Carl T. D'Angio, Abhik Das, Rosemary Higgins, Susan R. Hintz, Abbot R. Laptook, Girija Natarajan, Leif Nelin, Brenda B. Poindexter, Pablo J. Sanchez, Seetha Shankaran, Barbara J. Stoll, William Truog, Krisa P. Van MeursBetty Vohr, Michele C. Walsh, Haresh Kirpalani

Research output: Contribution to journalArticle

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Abstract

Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of 1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9). Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

Original languageEnglish (US)
Pages (from-to)1303-1310.e2
JournalJournal of Pediatrics
Volume164
Issue number6
DOIs
StatePublished - Jun 2014

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Tracheostomy
Premature Infants
National Institute of Child Health and Human Development (U.S.)
Vision Disorders
Vulnerable Populations
Hearing Loss
Nervous System
Counseling
Cohort Studies
Retrospective Studies
Logistic Models
Morbidity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Demauro, S. B., D'Agostino, J. A., Bann, C., Bernbaum, J., Gerdes, M., Bell, E. F., ... Kirpalani, H. (2014). Developmental outcomes of very preterm infants with tracheostomies. Journal of Pediatrics, 164(6), 1303-1310.e2. https://doi.org/10.1016/j.jpeds.2013.12.014

Developmental outcomes of very preterm infants with tracheostomies. / Demauro, Sara B.; D'Agostino, Jo Ann; Bann, Carla; Bernbaum, Judy; Gerdes, Marsha; Bell, Edward F.; Carlo, Waldemar A.; D'Angio, Carl T.; Das, Abhik; Higgins, Rosemary; Hintz, Susan R.; Laptook, Abbot R.; Natarajan, Girija; Nelin, Leif; Poindexter, Brenda B.; Sanchez, Pablo J.; Shankaran, Seetha; Stoll, Barbara J.; Truog, William; Van Meurs, Krisa P.; Vohr, Betty; Walsh, Michele C.; Kirpalani, Haresh.

In: Journal of Pediatrics, Vol. 164, No. 6, 06.2014, p. 1303-1310.e2.

Research output: Contribution to journalArticle

Demauro, SB, D'Agostino, JA, Bann, C, Bernbaum, J, Gerdes, M, Bell, EF, Carlo, WA, D'Angio, CT, Das, A, Higgins, R, Hintz, SR, Laptook, AR, Natarajan, G, Nelin, L, Poindexter, BB, Sanchez, PJ, Shankaran, S, Stoll, BJ, Truog, W, Van Meurs, KP, Vohr, B, Walsh, MC & Kirpalani, H 2014, 'Developmental outcomes of very preterm infants with tracheostomies', Journal of Pediatrics, vol. 164, no. 6, pp. 1303-1310.e2. https://doi.org/10.1016/j.jpeds.2013.12.014
Demauro SB, D'Agostino JA, Bann C, Bernbaum J, Gerdes M, Bell EF et al. Developmental outcomes of very preterm infants with tracheostomies. Journal of Pediatrics. 2014 Jun;164(6):1303-1310.e2. https://doi.org/10.1016/j.jpeds.2013.12.014
Demauro, Sara B. ; D'Agostino, Jo Ann ; Bann, Carla ; Bernbaum, Judy ; Gerdes, Marsha ; Bell, Edward F. ; Carlo, Waldemar A. ; D'Angio, Carl T. ; Das, Abhik ; Higgins, Rosemary ; Hintz, Susan R. ; Laptook, Abbot R. ; Natarajan, Girija ; Nelin, Leif ; Poindexter, Brenda B. ; Sanchez, Pablo J. ; Shankaran, Seetha ; Stoll, Barbara J. ; Truog, William ; Van Meurs, Krisa P. ; Vohr, Betty ; Walsh, Michele C. ; Kirpalani, Haresh. / Developmental outcomes of very preterm infants with tracheostomies. In: Journal of Pediatrics. 2014 ; Vol. 164, No. 6. pp. 1303-1310.e2.
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abstract = "Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of 1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83{\%} of infants with tracheostomies and 40{\%} of those without (OR adjusted for center 7.0, 95{\%} CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95{\%} CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95{\%} CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95{\%} CI 0.3-0.9). Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.",
author = "Demauro, {Sara B.} and D'Agostino, {Jo Ann} and Carla Bann and Judy Bernbaum and Marsha Gerdes and Bell, {Edward F.} and Carlo, {Waldemar A.} and D'Angio, {Carl T.} and Abhik Das and Rosemary Higgins and Hintz, {Susan R.} and Laptook, {Abbot R.} and Girija Natarajan and Leif Nelin and Poindexter, {Brenda B.} and Sanchez, {Pablo J.} and Seetha Shankaran and Stoll, {Barbara J.} and William Truog and {Van Meurs}, {Krisa P.} and Betty Vohr and Walsh, {Michele C.} and Haresh Kirpalani",
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T1 - Developmental outcomes of very preterm infants with tracheostomies

AU - Demauro, Sara B.

AU - D'Agostino, Jo Ann

AU - Bann, Carla

AU - Bernbaum, Judy

AU - Gerdes, Marsha

AU - Bell, Edward F.

AU - Carlo, Waldemar A.

AU - D'Angio, Carl T.

AU - Das, Abhik

AU - Higgins, Rosemary

AU - Hintz, Susan R.

AU - Laptook, Abbot R.

AU - Natarajan, Girija

AU - Nelin, Leif

AU - Poindexter, Brenda B.

AU - Sanchez, Pablo J.

AU - Shankaran, Seetha

AU - Stoll, Barbara J.

AU - Truog, William

AU - Van Meurs, Krisa P.

AU - Vohr, Betty

AU - Walsh, Michele C.

AU - Kirpalani, Haresh

PY - 2014/6

Y1 - 2014/6

N2 - Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of 1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9). Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

AB - Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N = 8683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI; a composite of 1 of developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed the impact of timing by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without (OR adjusted for center 7.0, 95% CI 5.2-9.5). After adjustment for potential confounders, odds of death or NDI remained higher (OR 3.3, 95% CI 2.4-4.6), but odds of death alone were lower (OR 0.4, 95% CI 0.3-0.7) among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life (aOR 0.5, 95% CI 0.3-0.9). Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.

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