Back Transfer of Infants with Tracheostomies: A Regional Center Experience

Abstract

We describe our center's experience with the back transfer of infants following tracheostomies. We conducted a retrospective cohort study of infants transferred to pediatric critical care units of our regional center with conditions originating in the neonatal period who underwent tracheostomy during the hospitalization within their first year of life between 2006 and 2017. Recovering patients are discharged home or transferred back to the referring hospitals. We evaluated patient characteristics, destination of discharge and type of pulmonary support at discharge, and mechanical ventilation (MV) or tracheotomy masks (TM). Of the 139 included patients, 72% were transferred to the neonatal intensive care unit, 21% to the pediatric cardiothoracic unit, and 7% to the pediatric intensive care unit. Their median gestational age was 35 weeks. They were admitted at a median 22 days of life and lived at a median distance of 56 miles from our center. Furthermore, 34 infants (24%) were back transferred closer to their homes (23 with MV and 11 with TM), and 84 (60%) were discharged home (53 on MV and 31 on TM). Twenty-one patients (15%) died in the hospital (before discharge or transfer). Back transferred patients on MV had a significantly shorter duration between tracheostomy and transfer compared with those discharged home from our center: MV (median = 22 vs. 103 days, p < 0.0001) and TM (median = 13 vs. 35 days, p < 0.0001). Back transfer of infants with tracheostomies closer to their homes was associated with a significantly shorter hospitalization and more efficient use of the subspecialized resources at the RC.

Keywords

utilization - access - safety - counseling - neonatal - resource

Publikationsverlauf

Eingereicht: 27. Januar 2021

Angenommen: 12. April 2021

Artikel online veröffentlicht:
19. Juni 2021

• References

• 1 Sterni LM, Collaco JM, Baker CD. et al; ATS Pediatric Chronic Home Ventilation Workgroup. An official American Thoracic Society clinical practice guideline: pediatric chronic home invasive ventilation. Am J Respir Crit Care Med 2016; 193 (08) e16-e35
• 2 Toly VB, Blanchette JE, Liu W. et al. Maternal stress and mental health prior to their technology-dependent infant's discharge home from the NICU. J Perinat Neonatal Nurs 2019; 33 (02) 149-159
• 3 González R, Bustinza A, Fernandez SN. et al; Spanish Children Home Mechanical Ventilation Multicentric Study Group. Quality of life in home-ventilated children and their families. Eur J Pediatr 2017; 176 (10) 1307-1317
• 4 Akangire G, Manimtim W, Nyp M. et al. Factors leading to rehospitalization for tracheostomized and ventilator-dependent infants through 2 years of age. J Perinatol 2017; 37 (07) 857-863
• 5 Attar MA, Hanrahan K, Lang SW, Gates MR, Bratton SL. Pregnant mothers out of the perinatal regionalization's reach. J Perinatol 2006; 26 (04) 210-214
• 6 Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics 2011; 127 (06) e1533-e1541
• 7 Jung AL, Bose CL. Back transport of neonates: improved efficiency of tertiary nursery bed utilization. Pediatrics 1983; 71 (06) 918-922
• 8 Bourque SL, Levek C, Melara DL, Grover TR, Hwang SS. Prevalence and predictors of back-transport closer to maternal residence after acute neonatal care in a regional NICU. Matern Child Health J 2019; 23 (02) 212-219
• 9 VON. 2020 Congenital anomaly codes (appendix C). [cited 2020 7/3/2020]. Accessed 2020 at: https://vtoxford.zendesk.com/hc/en-us/articles/360036536894-2020-Congenital-Anomaly-Codes-Appendix-C
• 10 Sobotka SA, Foster C, Lynch E, Hird-McCorry L, Goodman DM. Attributable delay of discharge for children with long-term mechanical ventilation. J Pediatr 2019; 212: 166-171
• 11 Lioy J, Hopkins E, Moran K. et al. Survival and decannulation after infant tracheostomy. Pediatrics 2018; 142: 558-558
• 12 Han SM, Watters KF, Hong CR. et al. Tracheostomy in very low birth weight infants: a prospective multicenter study. Pediatrics 2020; 145 (03) e20192371
• 13 Lee JH, Smith PB, Quek MB, Laughon MM, Clark RH, Hornik CP. Risk factors and in-hospital outcomes following tracheostomy in infants. J Pediatr 2016; 173: 39-44.e1 , e31
• 14 Roberts J, Powell J, Begbie J. et al. Pediatric tracheostomy: a large single-center experience. Laryngoscope 2020; 130 (05) E375-E380
• 15 Amin R, Sayal A, Syed F. et al. How long does it take to initiate a child on long-term invasive ventilation? Results from a Canadian pediatric home ventilation program. Can Respir J 2015; 22 (02) 103-108
• 16 Cottrill E, Lioy J, Elshenawy S. et al. A five year retrospective study of short term respiratory support outcomes for infants who received tracheostomy before one year of age. Int J Pediatr Otorhinolaryngol 2015; 79 (01) 15-17
• 17 Cassell CH, Krohmer A, Mendez DD, Lee KA, Strauss RP, Meyer RE. Factors associated with distance and time traveled to cleft and craniofacial care. Birth Defects Res A Clin Mol Teratol 2013; 97 (10) 685-695
• 18 Woo JL, Anderson BR, Gruenstein D, Conti R, Chua KP. Minimum travel distance among publicly insured infants with severe congenital heart disease: potential impact of in-state restrictions. Pediatr Cardiol 2019; 40 (08) 1599-1608