A study led by a CHOP neonatologist suggests that tracheostomy is a marker for a risk of adverse developmental outcomes for premature infants with severe lung disease.

While many premature infants must use a mechanical ventilator and extra oxygen for breathing, a minority ultimately undergo tracheostomy, which is the insertion of an artificial airway into the windpipe through a surgical incision to provide safe, long-term ventilation.

Sara B. DeMauro, MD, MSCE, an attending neonatologist and medical director of Neonatal Follow-up Programs at CHOP, and co-investigators looked at a dataset collected at 16 sites from 2001 to 2011 by the NICHD Neonatal Research Network. They identified 304 preterm infants with tracheostomies to include in a retrospective cohort study.

The researchers demonstrated that even when they performed adjusted analyses controlling for many of the factors known to be predictive of poor developmental outcomes in preterm infants, those with tracheostomies still had significantly increased odds of adverse outcomes. These outcomes consisted of neurologic impairment, developmental delay, or visual or hearing impairment.

"This study is an important first step in understanding what the range of outcomes for these children tends to be," Dr. DeMauro said. "When these data are combined with a child's individual clinical situation and any additional risk factors for poor outcomes, it allows you to make a much more informed decision about whether a tracheostomy is a good choice."

Dr. DeMauro pointed out that this study does not indicate that tracheostomy causes these developmental problems. Further data also is needed on the outcomes of tracheostomy in preterm infants who have lung disease compared to those who also have airway disease.

The study appeared in the Journal of Pediatrics, and received support from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development for the Neonatal Research Network.