Nationwide tracheostomy among neonatal admissions – A cross-sectional analysis

Objective: To describe characteristics and outcomes of infants admitted as neonates requiring tracheostomy placement. Methods: A cross-sectional analysis of the Kids’ Inpatient Database (KID) between 2003 and 2016 included all children admitted within the first 28 days of life that had a tracheostomy placed prior to discharge. Patient characteristics and surgical outcomes were compared between term (≥37 weeks gestation) and preterm (<37 weeks gestation) infants. A subset analysis for Black or African American neonates was performed given disproportional preterm births. Results: An estimated 4268 (95% CI: 4123–4414) tracheostomies were performed in infants admitted as a neonate with preterm infants accounting for 47% (1998/4268). Among preterm children, 20% were Black or African American compared to 12% in the term group (P < .001). More preterm infants had bronchopulmonary dysplasia (46% vs. 14%, P < .001), cardiac defects (66% vs. 58%, P < .001) and developed pneumonia, newborn sepsis, or sepsis during admissions (P < .001). Laryngotracheal anomalies (25% vs. 18%, P < .001) and vocal cord paralysis (11% vs. 4.9%, P < .001) were more common in term infants. Median length of stay (LOS) (154 vs. 100 days, P < .001) and total charges ($1,395,106 vs. $917,478, P < .001) were greater among preterm infants. Mortality was no different between groups (13% vs. 15%, P = .07). Characteristics strongly associated with preterm status were newborn sepsis (OR: 2.31, 95% CI: 1.97–2.72, P < .001), bronchopulmonary dysplasia (OR: 2.17, 95% CI: 1.77–2.65, P < .001) and Black or African American race (OR: 1.78, 95% CI: 1.46–2.17, P < .001). The following factors increased among all neonates between the baseline year 2003 to the final study year 2016: complications of care (OR: 1.9, 95% CI: 1.5–2.5, P < .001); sepsis (OR: 4.1, 95% CI: 3.0–5.5, P < .001); congenital cardiac anomalies (OR: 5.8, 95% CI: 4.5–7.4, P < .001); and respiratory failure (OR: 1.9, 95% CI: 1.5–2.4, P < .001). Compared to other races, median LOS and total charges were greater among Black or African American infants. Conclusion: Tracheostomies among preterm infants admitted as neonates reflect a growing and complex group with increased costs and hospitalization lengths. Black or African American children are disproportionately born preterm with higher costs and LOS compared to other racial cohorts. Future work will be necessary to design quality-improvement initiatives to improve outcomes for this vulnerable population.