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A nationwide survey on tracheostomy for very‐low‐birth‐weight infants in Japan
Author(s) -
Kurata Hiroaki,
Ochiai Masayuki,
Inoue Hirosuke,
Ichiyama Masako,
Yasuoka Kazuaki,
Fujiyoshi Junko,
Matsushita Yuki,
Honjo Satoshi,
Sakai Yasunari,
Ohga Shouichi
Publication year - 2019
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.24200
Subject(s) - medicine , low birth weight , bronchopulmonary dysplasia , birth weight , mechanical ventilation , sepsis , odds ratio , pediatrics , gestational age , pregnancy , genetics , biology
Objectives Tracheostomy is indicated for very‐low‐birth‐weight infants (VLBWIs) with prolonged respiratory problems during the perinatal period. The objective of this study is to clarify the epidemiology and risk factors in VLBWIs with tracheostomy after birth in Japan. Methods A total of 40 806 VLBWIs were registered in the Neonatal Research Network of Japan database from 2003 to 2012. Among them, 34 674 infants (85%) survived over 28 days after birth and were subjected to this study. The clinical variables at birth, outcomes at hospital discharge and associated factors for tracheostomy were examined. Results The proportion of VLBWIs with tracheostomy did not increase during the study period (mean 36 cases per year, 0.93%). The rate of in‐hospital death over 28 days after birth did not differ between tracheostomized and non‐tracheostomized infants (2/324, 0.6% vs 314/34 350, 0.9%). Tracheostomized infants more frequently had severe or moderate bronchopulmonary dysplasia (BPD) (75.5% vs 26.0%, P < 0.01) and longer hospitalization (229 days vs 83 days, P < 0.01) than non‐tracheostomized infants. Tracheostomized patients showed higher comorbidities with hypoxic ischemic encephalopathy (odds ratio [OR] 10.98, P < 0.01), muscular disease (OR 10.95, P < 0.01), severe or moderate BPD (OR 7.79, P < 0.01), chromosomal abnormality (OR 4.43, P < 0.01) or sepsis (OR 1.78, P < 0.05) at hospital discharge than non‐tracheostomized patients. Conclusion We demonstrated the non‐increasing rate in tracheostomy for VLBWIs and such cases were associated with an excellent survival in Japan. These data provide evidence that more attentive care must be practiced in order to reduce the pulmonary and neuromuscular burdens of VLBWIs at birth.