Background: Very preterm infants with bronchopulmonary dysplasia (BPD) require tracheostomy when withdrawal from invasive ventilation is difficult.However, information regarding in-hospital mortality is limited.The present study aimed to describe the in-hospital courses following tracheostomy and to examine the clinical factors associated with in-hospital death.Methods: This retrospective study used a Japanese national inpatient database.We included all infants born at < 32 weeks' gestational age or with a birthweight < 1500 g between July 2010and March 2020 who underwent tracheotomy secondary to BPD (supplementary oxygen, noninvasive ventilation, or mechanical ventilation at 36 weeks corrected gestational age).Prolonged-steroid-exposed BPD was defined as hydrocortisone or dexamethasone use for 7 cumulative days, while severe pulmonary hypertension (PHT) was defined as inhaled nitric oxide or pulmonary vasodilator use for 7 cumulative days before tracheostomy.Multivariable Cox regression models were applied to assess factors associated with in-hospital death after tracheostomy.Results: Among 18,056 very preterm patients with BPD, 484 underwent tracheostomy.After excluding those with major congenital anomalies, 294 were eligible.The median age at tracheostomy was 174 days (interquartile range, 129-244 days).Of these, 47 (16.0%) patients died, and the median time from tracheostomy to death was 125 days (interquartile range, 59-J o u r n a l P r e -p r o o f 339 days).Prolonged-steroid-exposed BPD (adjusted hazard ratio aHR, 3.08; 95% confidence interval CI, 1.35-6.99)and prolonged-steroid-exposed BPD/PHT (aHR, 5.93; 95% CI, 2.89-12.17),but not corrected gestational age of tracheostomy (aHR, 1.01; 95% CI, 1.00-1.02)were associated with death. Conclusions:In very preterm patients who underwent tracheostomy secondary to BPD, prolonged-steroid-exposed BPD and BPD/PHT before tracheostomy were associated with inhospital mortality.
Ikuta et al. (Fri,) studied this question.