- Neonatal intubation adverse event (AE) rates increase with a procedural indication of unstable hemodynamics and number of intubation attempts.
- Rates decrease with use of paralytic premedication and video laryngoscopy.
Why this matters
- Given the potential dangers of this life-saving procedure, identifying factors that increase or reduce AE rates is important.
- This contemporary, multisite study reflects current practice.
- First attempt success rate in neonatal ICU (NICU) was 49%; 46% in delivery room (DR); affected by training level.
- ≥1 AE in 18% of NICUs, 17% of DRs.
- Most common nonsevere AEs: esophageal intubation with immediate recognition, dysrhythmia, mainstem bronchial intubation.
- Most common severe AEs: esophageal intubation with delayed recognition, cardiac compressions lasting
- Factors reducing AEs:
- Video laryngoscope: aOR, 0.46 (95% CI, 0.28-0.73).
- Paralytic premedication: aOR, 0.38 (95% CI, 0.25-0.57).
- Factors increasing AEs:
- Indication was unstable hemodynamics: aOR, 3.85 (95% CI, 1.59-9.35).
- More intubation attempts: aOR, 1.87 (95% CI, 1.63-2.14).
- 2607 intubations (2009 in NICU), 10 centers, October 1, 2014-March 31, 2017.
- Funding: NIH.
- Center-reported AE, success rates.
- Duration of attempts not known.