Objective: To analyze the clinical characteristics of neonatal tracheotomy in neonatal intensive care unit (NICU). Methods: This single-center retrospective study included 14 neonates admitted to NICU of Beijing Children's Hospital, Capital Medical University from January 2016 to August 2021, and were<28 days of age on admission, who met the criteria of tracheotomy and finally completed the procedure. The clinical characteristics including age, weight, duration of ventilation, etiology of tracheotomy, length of hospital stay and prognosis were summarized and analyzed. Wilcoxon signed-rank test was used to compare the weight gain velocity and the duration of ventilation before and after tracheotomy. Paired t-test was used to compare the hospitalization length before and after tracheotomy. Spearman correlation was used to analyze the correlation between the clinical characteristics and outcomes. Results: For the 14 neonates, the gestational age was (38±4) weeks and birth weight was (2 824±949) g. Nine of them were male. The age on transportation was 16 (6, 25) d. A total of 10 neonates were on invasive ventilation on admission, the other 4 were on nasal continuous positive airway pressure support. Bilateral vocal cord paralysis (7 cases) was the commonest cause of tracheotomy. The age on operation was 33 (22, 44) d. There were statistically significant differences in duration of ventilation and weight gain velocity before and after operation (19.00 (10.50, 34.00) vs. 0.86 (0.06, 3.25) d, 1.66 (-0.16, 5.54) vs. 4.69 (2.30, 9.32) g/(kg·d), Z=3.01 and -1.98, both P<0.05). The total hospital stay in NICU was (37±12) d. One neonate died during hospitalization. The existence of pneumonia on admission was positively correlated to NICU stay length (r=0.57, P=0.027), the pre-operational weight gain velocity was negatively correlated to the post-operational NICU stay length (r=-0.73, P=0.020). There were 4 neonates de-cannulated during 7-38 months after the tracheotomy, and 5 neonates still wearing the tracheal cannulation during 15-66 months after the tracheotomy. Two neonates died and 2 neonates lost follow-up after discharge. All neonates could not vocalize normally before de-cannulation, and the language development obviously lagged behind the normal age group after de-cannulation. Conclusions: Bilateral vocal cord paralysis is the commonest cause of neonatal tracheotomy. The benefit of tracheotomy for NICU neonates with surgical indications is obvious, especially in facilitating extubation and improving weight gain.
目的： 总结新生儿重症监护病房（NICU）完成气管切开术患儿的临床特征。 方法： 单中心回顾性研究，纳入2016年1月至2021年8月于首都医科大学附属北京儿童医院新生儿中心NICU住院的入院<28 日龄、符合气管切开指征且最终完成该手术的14例患儿。收集患儿年龄、体重、呼吸支持时间、手术病因、住院时间等临床特征及预后资料进行总结分析。采用Wilcoxon秩和检验对患儿气管切开术前后的自身体重增长速率和气管插管呼吸支持时间进行配对比较，配对t检验对患儿气管切开术前后住院时间进行比较，采用Spearman相关分析对患儿临床特征与住院结局之间的相关性进行统计分析。 结果： 14例患儿出生胎龄为（38±4）周，出生体重为（2 824±949）g，男9例，入院年龄为16（6，25）日龄，其中10例患儿经气管插管呼吸支持、4例经鼻持续气道正压通气呼吸支持。最常见的病因为双侧声带麻痹（7例）。患儿接受气管切开手术的年龄为33（22，44）日龄，手术前后的呼吸支持时间和体重增长速率差异均有统计学意义［19.00（10.50，34.00）比0.86（0.06，3.25）d，1.66（-0.16，5.54）比4.69（2.30，9.32）g/（kg·d），Z=3.01、-1.98，均P<0.05］。住院时间为（37±12）d，住院期间死亡1例。入院时存在肺部感染与住院总时长呈正相关（r=0.57，P=0.027），气管切开术前的体重增长速率与气管切开术后住院天数呈负相关（r=-0.73，P=0.020）。4例患儿已成功拔除气管套管（戴管时间为7~38个月），5例患儿仍未拔除气管套管（戴管时间已15~66个月），2例患儿出院后死亡，2例失访。所有患儿在拔除气管套管前均无法正常发音，拔除气管套管后的语言发育亦明显落后于正常同龄儿。 结论： 双侧声带麻痹是新生儿最常见的气管切开病因。气管切开术对患儿脱离呼吸支持和体重增长是有利的，可能有助于改善患儿的总体预后。.