Abstract Rationale Bronchopulmonary dysplasia (BPD) is associated with morbidity, mortality, and neurodevelopmental impairment (NDI). Previous literature suggests that early tracheostomy placement (TP) may reduce the risk of death and NDI, however results have been conflicting. Additionally, the timing of tracheostomy placement for each individual patient, family, and medical team is complex. Based on recent studies, we defined early tracheostomy as trach placement 44 wks corrected gestational age and compared to the previous 120 DOL threshold. . Our study aimed to identify the effect of early tracheostomy placement in moderate and severe BPD on long-term growth and pulmonary outcomes. Additionally, we sought to assess the feasibility of abstracting family-centered outcomes (see, talk, walk, eat, and diagnosis of cerebral palsy) from the EMR. Methods Inclusion criteria: Infants with grade 2/3 BPD with TP during their initial hospitalization from 8/24/2013 to 12/31/2018 at Children’s Nebraska or University of Nebraska Medical Center(UNMC). Exclusion: ward of the state, known genetic condition/syndrome, or complex congenital heart disease. 5-year outcomes were obtained from follow-up through 5/19/2023. The data was abstracted from Epic and stored in Redcap prior to analysis. Fisher’s exact tests were used to look at the association of Categorical variables with trach placement groups. Continuous data were compared between the Trach placement groups using the independent samples test or Wilcoxon rank sum test (if data was considered non-normal). All analyses were performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC). A p-value 0.05 was considered statistically significant. Results Nine infants had early TP with 12 with late TP. As reported previously, the only difference between the two groups at TP was the presence of pulmonary hypertension. Timing of TP did not lead to a significant difference in weight, length, and WFL z-scores in the first five years post TP. Time to vent liberation was lower in the early vs late TP group (5.23 vs 20.6 months), however this was not statistically significant (p = 0.075). Conclusion In this single center retrospective study, timing of TP was associated with an earlier discharge but not with a statistically significant difference in growth or long-term pulmonary outcomes. There were no differences in using 120 days of life or less than 44 weeks corrected in determining clinical outcomes (both had non-significant changes). Many of the family-centered outcomes were either missing or not clearly defined in the available documentation, which is important to improve in future studies. This abstract is funded by: Child Health Research Institute at UNMC/Children’s Hospital & Medical Center
Rhoads et al. (Fri,) studied this question.