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American Academy of Pediatrics
Article

Tracheostomy in Infants in the Neonatal Intensive Care Unit

Julia Chang and Douglas R. Sidell
NeoReviews May 2020, 21 (5) e323-e334; DOI: https://doi.org/10.1542/neo.21-5-e323
Julia Chang
*Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
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Douglas R. Sidell
*Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
†Stanford Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford, CA
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  • Abbreviations:
    AAO-HNS:
    American Academy of Otolaryngology–Head and Neck Surgery
    ASPO:
    American Society of Pediatric Otolaryngologists
    ATS:
    American Thoracic Society
    BPD:
    bronchopulmonary dysplasia
    HH:
    heated humidifier
    HME:
    heat and moisture exchanger
    IPOG:
    International Pediatric Otolaryngology Group
    PSG:
    polysomnography
    SBS:
    State Behavioral Scale
    SLP:
    speech-language pathologist
    VFSS:
    videofluoroscopic swallow study
  • Abstract

    Approximately half of all pediatric tracheostomies are performed in infants younger than 1 year. Most tracheostomies in patients in the NICU are performed in cases of chronic respiratory failure requiring prolonged mechanical ventilation or upper airway obstruction. With improvements in ventilation and management of long-term intubation, indications for tracheostomy and perioperative management in this population continue to evolve. Evidence-based protocols to guide routine postoperative care, prevent and manage tracheostomy emergencies including accidental decannulation and tube obstruction, and attempt elective decannulation are sparse. Clinician awareness of safe tracheostomy practices and larger, prospective studies in infants are needed to improve clinical care of this vulnerable population.

    • Copyright © 2020 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 21, Issue 5
    1 May 2020
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    Tracheostomy in Infants in the Neonatal Intensive Care Unit
    Julia Chang, Douglas R. Sidell
    NeoReviews May 2020, 21 (5) e323-e334; DOI: 10.1542/neo.21-5-e323

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    Tracheostomy in Infants in the Neonatal Intensive Care Unit
    Julia Chang, Douglas R. Sidell
    NeoReviews May 2020, 21 (5) e323-e334; DOI: 10.1542/neo.21-5-e323
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    • Article
      • Abstract
      • Education/Practice Gaps
      • Objectives
      • Introduction
      • Indications for Tracheostomy
      • Neonatal Airway Anatomy
      • Surgical Tracheostomy
      • Routine Postoperative Care
      • Management of Tracheostomy-Related Complications
      • Airway Surveillance and Decannulation
      • Summary
      • Footnotes
      • References
    • Figures & Data
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    • Comments
    • Quiz

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