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Background: External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm., Methods: A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone., Results: A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality., Conclusion: Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes., Competing Interests: Declaration of competing interest The authors of the manuscript titled ‘External peri-stomal skin granulations in paediatric tracheostomy: incidence, outcomes and a proposed treatment algorithm’ declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Tracheostomy techniques, indications and care are extensively covered in the literature. However, little is written about the process of removing the tracheostomy tube. At the Royal Hospital for Sick Children in Glasgow we use a stepwise ward-based protocol for safe tracheostomy decannulation. Our aim therefore was to review all the paediatric tracheostomy decannulations that we attempted over the last 3 years to evaluate our protocol, to determine our success rate and to see whether any modifications to the protocol are required., Method: We reviewed all patients who had undergone ward decannulation between January 2012 and May 2015. We extracted data from clinical records including patient characteristics, indications for tracheostomy, timing of decannulation and success or failure of the process., Results: The 45 children in the study underwent 57 attempts at decannulation during the study period. 25 were male (56%) and 20 were female (44%), and they were aged between 1 day and 16 years 6 months at the time of the original tracheostomy operation. 33 attempts were successful (58%). 10 children had more than one attempt at decannulation. Children were found to fail at every stage of the protocol, with the commonest point of failure being day 2 when the tracheostomy tube was capped., Discussion: We have demonstrated that our current protocol for ward decannulation is effective and safe, and that all five days of the protocol are required., (Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.)

Aims: The aim of this paper was to review the indications, complications and outcomes for tracheostomy at a Scottish paediatric tertiary referral hospital., Methods: All patients undergoing tracheostomy between January 2001 and September 2012 were identified. A retrospective case note analysis was performed., Results: 111 tracheostomies were done in the study period. The mean number per year was 11 (3-12). Full data was available for 95 patients. There were 56 (59%) males and 39 (41%) females. Age at time of tracheostomy ranged from one day to 15 years, the mean age of tracheostomy insertion was 69 weeks. The majority of patients, 75 (79%), were under one year old when they had their tracheostomy. The most common indication was long-term ventilation (20%), followed by craniofacial abnormality causing airway obstruction (18%), followed by subglottic stenosis (14%). 37% of patients were decannulated., Conclusions: This series reflects current trends in the indications for paediatric tracheostomy, with chronic lung disease of prematurity being the most common indication., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: This paper presents our experience of managing children with a tracheostomy in a multidisciplinary team clinic consisting of an ENT consultant, paediatric respiratory consultant, a nurse specialist, and speech and language therapist., Method: A retrospective case note review was conducted of all children seen in the multidisciplinary team tracheostomy clinic (at a tertiary paediatric hospital) between February 2009 and September 2014., Results: Ninety-seven patients were examined. The most common indications for tracheostomy were: lower airway and respiratory problems (66 per cent), upper airway obstruction (64 per cent), and neurodevelopmental problems (60.8 per cent)., Conclusion: Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. Our unified approach empowers the carers and patient, as a home management plan, long-term plan and goals are generated at the end of each appointment.

Background: Congenital airway obstruction is rare but potentially fatal. We developed a complex airways interventional delivery team to manage such cases. Antenatal imaging detects airway compromise at an early stage and facilitates the planning of delivery procedures ('ex utero intrapartum treatment' and 'operation on placental support') which maintain feto-placental circulation whilst an airway is secured., Method: A retrospective review was performed of cases in which ENT input was required at birth for airway obstruction., Results: Four neonates were delivered before implementation of the service: two were intubated and another two underwent tracheostomy but died in the peri-natal period. Seven neonates were delivered after implementation of the service: six were intubated and one underwent immediate tracheostomy. Five subsequently underwent tracheostomy (three have since been decannulated). One child with multiple congenital anomalies died due to respiratory failure. Airway obstruction was caused by lymphatic malformation, teratoma, costo-craniomandibular syndrome and choristoma., Conclusion: In the absence of other anomalies, interventional airway delivery led to reduced mortality and improved outcomes.

Expanding indications for airway and head and neck surgery have led to a number of children under 18 months of age being deemed suitable for decannulation of their tracheostomies. We present four cases to illustrate the particular problems encountered in this age group and suggest modifications to our previously-published decannulation protocol.