. 2021;118(4):470-478.

doi: 10.1159/000515872. Epub 2021 May 4.

Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

Megan M Gray¹, Jennifer A Rumpel², Brianna K Brei³, Jeanne Alexandra Krick⁴, Taylor Sawyer¹, Kristen Glass⁵, Stephen DeMeo⁶, James Barry⁷, Anne Ades⁸, Natalie Napolitano⁹, Lindsay Johnston¹⁰, Ahmed Moussa¹¹, Phillip Jung¹², Bin Huey Quek¹³, Ayman Abou Mehrem¹⁴, Jeanne Zenge¹⁵, Justine Shults¹⁶, Vinay Nadkarni¹⁷, Jae Kim¹⁸, Neetu Singh¹⁹, Alicia Tisnic²⁰, Elizabeth Foglia²¹, Akira Nishisaki²²; National Emergency Airway Registry for Neonates: NEAR4NEOS Investigators

Affiliations

¹ University of Washington School of Medicine, Seattle, Washington, USA.
² Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, USA.
³ Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁴ Madigan Army Medical Center, Tacoma, Washington, USA.
⁵ Penn State College of Medicine, Penn State Health, Hershey, Pennsylvania, USA.
⁶ Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
⁷ University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, Colorado, USA.
⁸ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁹ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA.
¹¹ Department of Pediatrics, University of Montreal, Montreal, Québec, Canada.
¹² Department of Pediatrics, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
¹³ Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
¹⁴ Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁶ Children's Hospital of Philadelphia, Ambler, Pennsylvania, USA.
¹⁷ Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁸ Perinatal Institute, Cincinnati, Ohio, USA.
¹⁹ Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
²⁰ Alberta Children's Hospital, Alberta, Alberta, Canada.
²¹ Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²² Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

PMID: 33946064
PMCID: PMC8376756
DOI: 10.1159/000515872

Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

Megan M Gray et al. Neonatology. 2021.

. 2021;118(4):470-478.

doi: 10.1159/000515872. Epub 2021 May 4.

Authors

Affiliations

¹ University of Washington School of Medicine, Seattle, Washington, USA.
² Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, USA.
³ Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁴ Madigan Army Medical Center, Tacoma, Washington, USA.
⁵ Penn State College of Medicine, Penn State Health, Hershey, Pennsylvania, USA.
⁶ Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA.
⁷ University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, Colorado, USA.
⁸ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁹ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA.
¹¹ Department of Pediatrics, University of Montreal, Montreal, Québec, Canada.
¹² Department of Pediatrics, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
¹³ Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
¹⁴ Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
¹⁵ Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁶ Children's Hospital of Philadelphia, Ambler, Pennsylvania, USA.
¹⁷ Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁸ Perinatal Institute, Cincinnati, Ohio, USA.
¹⁹ Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
²⁰ Alberta Children's Hospital, Alberta, Alberta, Canada.
²¹ Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
²² Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

PMID: 33946064
PMCID: PMC8376756
DOI: 10.1159/000515872

Abstract

Introduction: Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear.

Objective: To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets.

Methods: Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites.

Results: Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success.

Conclusions: Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes.

Keywords: Airway injury; Difficult airway; Neonatal intubation; Stylet; Tracheal intubation-associated events.

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Conflict of interest statement

Conflict of Interest Statement: The authors have no conflicts of interest to declare.

Figures

**Figure 2**
Use of Stylets for Intubation by NEAR4NEOS Center

See this image and copyright information in PMC

References

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Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

Affiliations

Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources