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Pediatrics. 2019 Jan;143(1). pii: e20180902. doi: 10.1542/peds.2018-0902. Epub 2018 Dec 11.

Neonatal Intubation Practice and Outcomes: An International Registry Study.

Author information

1
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; foglia@email.chop.edu.
2
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.
4
Penn State Health Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania.
5
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
6
Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany.
7
KK Women's and Children's Hospital, Singapore, Singapore.
8
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut.
9
Department of Pediatrics, Section of Neonatology, School of Medicine, University of Colorado, Aurora, Colorado.
10
Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.
11
Division of Neonatology, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital of San Diego, San Diego, California.
12
WakeMed Health and Hospitals, Raleigh, North Carolina; and.
13
Departments of Nursing, Respiratory Care and Neurodiagnostic Services and.
14
Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Abstract

BACKGROUND AND OBJECTIVES:

Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety.

METHODS:

We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. Safety outcomes included adverse tracheal intubation-associated events (TIAEs) and severe oxygen desaturation (≥20% decline in oxygen saturation). We examined the relationship between intubation characteristics and adverse events with univariable tests and multivariable logistic regression.

RESULTS:

We captured 2009 NICU intubations and 598 DR intubations from 10 centers. Pediatric residents attempted 15% of NICU and 2% of DR intubations. In the NICU, the first attempt success rate was 49%, adverse TIAE rate was 18%, and severe desaturation rate was 48%. In the DR, 46% of intubations were successful on the first attempt, with 17% TIAE rate and 31% severe desaturation rate. Site-specific TIAE rates ranged from 9% to 50% (P < .001), and severe desaturation rates ranged from 29% to 69% (P = .001). Practices independently associated with reduced TIAEs in the NICU included video laryngoscope (adjusted odds ratio 0.46, 95% confidence interval 0.28-0.73) and paralytic premedication (adjusted odds ratio 0.38, 95% confidence interval 0.25-0.57).

CONCLUSIONS:

We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events. Our results will inform future interventional studies to improve neonatal intubation safety.

PMID:
30538147
PMCID:
PMC6317557
DOI:
10.1542/peds.2018-0902
[Indexed for MEDLINE]
Free PMC Article

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