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Improved growth and developmental activity post tracheostomy in preterm infants with severe BPD
Author(s) -
Luo Jun,
Shepard Suzanne,
Nilan Kathleen,
Wood Audrey,
Monk Heather M.,
Jensen Erik A.,
Harrington Ann T.,
Maschhoff Kathryn,
Kirpalani Haresh,
Feng Zhichun,
Zhang Huayan
Publication year - 2018
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24087
Subject(s) - medicine , bronchopulmonary dysplasia , neonatal intensive care unit , pediatrics , birth weight , sedation , gestation , gestational age , surgery , pregnancy , genetics , biology
Objectives To examine growth, sedation needs, and participation in developmental activities before and after tracheostomy among infants with severe bronchopulmonary dysplasia. Methods Retrospective analysis of infants born at <32 weeks’ gestation or birth weights <1500 g with severe BPD who underwent tracheostomy placement between January 1, 2010 and December 31, 2016 in a quaternary referral newborn and infant intensive care unit. Changes in growth parameters and frequency/type of participation in physical therapy sessions performed during the 4‐weeks before tracheostomy and 4‐weeks after the first tracheostomy tube change were compared. Results A total of 72 patient were included in the study. Average weekly gain in weight, length, and head circumference were significantly higher during the 4‐week period after compared to before tracheostomy. The most significant change occurred for linear growth (0.71 ± 0.40 cm/wk pre vs 0.97 ± 0.48 cm/wk pre, P < 0.001). Median Z score improved for weight (pre −1.42 [−3,10, −0.33] vs post −0.91 [−2.7, 0.27], P < 0.001), length (pre −3.07 [−4.39, −1.31] vs post −1.95 [−3.83, −0.93], P < 0.001) and weight‐to‐length ratio (pre 1.66 [0.58, 2.55] vs post 1.32 [0.17, 2.2], P = 0.02). Participation in developmental therapies significantly improved post tracheostomy (pre vs post: 5.2 ± 2.9 vs 8.7 ± 4.3 sessions performed over 4 weeks, P < 0.0001). Physical therapy sessions more often promoted developmental skill acquisition after tracheostomy compared to facilitating physiologic stability before tracheostomy. Daily sedation requirements decreased post tracheostomy. Conclusions Tracheostomy was associated with improved proportional growth and increased participation in activities promoting developmental skill acquisition and reduced daily sedation requirements in preterm infants with severe BPD.