Neonatal intubation: these factors affect adverse events

  • Pediatrics

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 2607 intubations (2009 in NICU), 10 centers, October 1, 2014-March 31, 2017.
  • Funding: NIH.

Limitations

  • Center-reported AE, success rates.
  • Duration of attempts not known.

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