Use of palliative care services in NICU patients undergoing tracheostomy: Enhancing decision-making and care with an underutilized discipline.

INTRODUCTION

Palliative care provides a proactive, family-centered approach for infants with life-threatening conditions. We examined the frequency of palliative care consultations among NICU tracheostomy patients and their associated demographics, hypothesizing that it is mainly used for high-risk infants but could benefit a broader group.

METHODS

Charts of all NICU patients who underwent tracheostomy between 1/1/2012-12/31/2020 at a tertiary care NICU were reviewed for demographics, comorbidities, and palliative care consults. Outcomes were compared for preoperative consult vs. no-consult groups using chi-square and fisher's exact tests, with significance set at p < 0.05.

RESULTS

Among 171 infants, 13.5% received perioperative palliative care consults. Sex did not differ, but race did (p < 0.001), with African-American/Black infants predominating. Infants receiving palliative care consults had greater gestational age (36.7 vs 32.5 weeks, p = 0.02), more neurologic indications (43.5% vs 17.5%, p = 0.01), and fewer cardiac (21.9% vs 57.1%, p = 0.002) and pulmonary comorbidities (34.8% vs 59.1%, p = 0.04). Median rates of perioperative consults were higher in the consulted group (15 vs 13, p = 0.04). No differences were seen in rates of discharge on a ventilator (95.6% vs 80.5%, p = 0.1), 1-year decannulation (0% vs 3.4%, p = 1), or mortality (4.4% vs 12.2%, p = 0.5). At 5 years, palliative care patients were less likely to be decannulated (4.35% vs 35.81%, p = 0.001), with no differences in mortality (47.83% vs 32.43%, p = 0.2).

CONCLUSIONS

Palliative care was underutilized in NICU tracheostomy patients. Consults were more frequent in neurologic cases and less common in cardiac, pulmonary, or anatomic obstruction, despite similarly complex post-discharge courses. Expanding palliative care access in this population could improve family-centered decision-making, coordination, and long-term planning.