Tracheostomy in Infants in the Neonatal Intensive Care Unit

Julia Chang; Douglas R. Sidell

doi:10.1542/neo.21-5-e323

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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.