Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb;36(2):112-5.
doi: 10.1038/jp.2015.158. Epub 2015 Nov 5.

Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants

M B Wallenstein  1 , K L Birnie  1 , Y H Arain  1 , W Yang  1 , N K Yamada  1 , L C Huffman  1 , J P Palma  1   2 , V Y Chock  1 , G M Shaw  1 , D K Stevenson  1
Affiliations

Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants

M B Wallenstein et al. J Perinatol. 2016 Feb.

Abstract

Objective: To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.

Study design: A retrospective chart review was conducted for all ELBW infants ⩽1000 g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5 min of life or if intubation was attempted during the first 10 min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.

Results: The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.

Conclusion: Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.

PubMed Disclaimer

References

    1. Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, et al. Neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010. 122:S516–538. - PubMed
    1. Kattwinkel J, editor. Textbook of Neonatal resuscitation. 4th ed. American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program; Elk Grove, IL: 2000.
    1. O'Donnell CPF, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics. 2006;117:e16–21. - PubMed
    1. Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL. Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med. 1984;12:5010–3. - PubMed
    1. Kelly MA, Finer NN. Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. J Pediatr. 1984;105:303–9. - PubMed