Extremely Preterm Infants Have Equivalent Decannulation Success but More Complications Post-LTR

by Linda Kossoff •

CLINICAL QUESTION

What are the decannulation rates, time to decannulation, and complication rates between laryngotracheal reconstruction (LTR) patients born extremely prematurely when compared with children born preterm and term?

BOTTOM LINE

Compared with all other patients, extremely premature (EP) infants have equivalent decannulation success but are at an increased risk for complications following LTR.

BACKGROUND: Approximately 6% of all preterm births take place at 28 weeks gestational age or younger. Many of the resulting EP neonates suffer from comorbidities and require tracheostomy early in life and subsequent LTR; however, there is no known study to date examining post-LTR outcomes in EP patients.

STUDY DESIGN: Multi-cohort study.

SETTING: Department of Pediatric Otolaryngology, Children’s National Medical Center, Washington, D.C.

SYNOPSIS: Researchers compared cohorts of EP, premature (PR), and full-term (FT) LTR patients in terms of decannulation failure, time to decannulation, and postoperative complications. They identified 179 patients (59.22% male) treated at a tertiary children’s hospital who underwent open airway reconstruction from 2008 to 2021. Of the 179 patients, 81, 38, and 23 were EP, PT, and FT, respectively. Preoperatively, the EP cohort was more likely to have a pulmonary comorbidity and to present with tracheostomy prior to their initial LTR. There was no difference in the percentage of patients with EP, PR, or FT requiring revision LTR, and no difference in time to or rate of cannulation among the groups. However, compared with the other groups, EP patients were more likely to require an anterior and posterior graft at the time of surgery, have a postoperative tracheocutaneous fistula, and suffer two or more complications. Researchers noted that EP infants requiring open airway surgery are more likely to be African American, whereas FT patients are more likely to be Caucasian or Asian American. Study limitations included its retrospective nature.

CITATION: Blumenthal D, Leonard JA, Habib A, et al. Laryngotracheal reconstruction outcomes in children born extremely premature. Laryngoscope. 2023;133:3608–3614.