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60 DEVELOPMENTAL OUTCOME IN INFANT TRACHEOSTOMY

Twenty-one survivors of long-term tracheostomy in infancy were seen for developmental follow-up at a mean age of 4.7 years (SD=1.6). Measures of intellectual ability (standardized IQ tests), growth (weight for age), and social and behavioral competence based on Child Behavior Checklist (CBC) were taken. The sample was primarily white (67%), male (57%) and middle class with a mean length of tracheostomy of 44 months (SD=31). Almost half (45%) were prematures with 30% VLBW. One-quarter had some indication of neurological damage, although children with documentable mental retardation were excluded from follow-up. The group as a whole achieved a mean Full Scale IQ of 89.9 (SD=16), in the low normal range. Mean percentile of weight for age was 42.6 (SD=24). The majority of children showed significant behavioral and social problems with 70% scoring in the deviant range on at least one subscale of the CBC. Correlational analyses indicated that, within this sample, prematurity was associated with lowered IQ (r=.59, p <.003) and poorer behavioral functioning (r=.42, p <1.05). Neurological impairment (r=.49, p <.03) and socioeconomic status (r=.68, p<.002) were associated with behavioral difficulties, but not intellectual problems. The present data suggest that the impact of infant tracheostomy on later development is complex and interactive with other biological and environmental factors.