450 - Outcomes of Tracheostomy and Home Ventilation Through Four Years of Life in Severe Bronchopulmonary Dysplasia

Poster Number: 450
Publication Number: 450.431

Gangaram Akangire, Childrens Mercy Kansas City, Kansas City, MO, United States; Charisse I. Lachica, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Addie G. Begley, Children's Mercy Hospitals and Clinics, Spring Hill, KS, United States; Janelle Noel-MacDonnell, Children’s Mercy Hospital, Kansas City, MO, United States; Venkatesh Sampath, Childrens Mercy Kansas City, Kansas City, KS, United States; William Truog, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Winston Manimtim, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Forty percent of pediatric tracheostomy is performed in children under 1 year of age. The significant increase in the rate of tracheostomy in infants is partly attributed to the increased survival of extremely premature infants who develop severe BPD and require long-term ventilation. Literature on the outcomes of infants with severe BPD who had tracheostomy is limited. Knowledge of these outcomes will help clinicians and families to make well informed decisions.

Objective: To describe the survival rate, timing of liberation from home ventilator, decannulation and hospital readmission rates of infants with severe BPD who had tracheostomy.

Design/Methods: A retrospective study was conducted on 118 infants born between 2004-2017 with severe BPD and tracheostomy performed at < 1 year of age and cared for in the Infant Tracheostomy and Home Ventilator Clinic through 4 years of age.

Results: The number of severe BPD patients with tracheostomy increased significantly from 2004-2017. (Figure 1) 118 infants were included in the cohort, 103 had tracheostomy and ventilator dependence at the time of discharge while 15 had tracheostomy only. Median gestational age at birth was 26 weeks (IQR 24, 28). Median birth weight was 735 grams (IQR 580, 930). Median age at tracheostomy was 4 months (IQR 3, 5) chronologic age, (or 43 weeks corrected age). Median age at NICU discharge was 7 months (IQR 5.5, 9). Median age of liberation from home ventilator was 23 months (IQR 18, 28). 50 (43%) infants were decannulated by 4 years of age. Of the decannulated infants, median age at decannulation was 31.5 months (IQR 26, 39). (Figure 2) Mortality rate was 10%, the most common cause of death was tracheostomy plugging and accidental decannulation leading to cardiac arrest. (Figure 3) Median age at death was 11.5 months (IQR 8, 21). 93% received gastrostomy tube and 32.5% had polysomnogram prior to decannulation. 34 (29%) infants had pulmonary hypertension at the time of discharge. 37(31.5%) patients required upper airway surgery prior to decannulation. Number of rehospitalizations from initial discharge to 12 months of age were 109 occurrences, from 13-24 months of age were 118, and from 25-36 months were 69, 75% were due to acute respiratory conditions.Conclusion(s): Infants with severe BPD and tracheostomy with ventilator dependence remain at risk of mortality through 4 years of age. Majority of rehospitalizations occur in the first 2 years of life and related to acute respiratory conditions. Future goals include validation of our findings in a multicenter fashion and identification of predictive factors for improved outcomes.
Figure 1Cohort of Severe BPD with Tracheostomy and Home Ventilator Dependence from 2004-2017
Figure 2Kaplan Meier curve showing 43% decannulation in the cohort through 4 years of age