Standardized endotracheal tube and intravascular access placement in infants born at 22-23 weeks gestation

Abstract

Background: Recommendations are limited regarding the placement of oral endotracheal tube (ETT), and umbilical arterial/venous catheter (UAC/UAC) in the tiniest extremely preterm infants. We aimed to determine optimal insertion depths, and assess the impact of a too deep ETT position on outcomes.

Methods: All infants born at 22-23 weeks gestation in 2019-2024 at Uppsala University Hospital, Sweden, were evaluated radiologically for accurate positions defined as: ETT (not right-sided/in main bronchus), UAC (T6-9 or L3-4), and UVC (right atrium/inferior vena cava junction). ETT position was further analyzed in relation to time to first extubation, respiratory severity score, duration of mechanical ventilation, bronchopulmonary dysplasia, and mortality.

Results: The cohort (n = 75; 22w n = 39; 23w n = 36) had a survival rate of 41 and 64%, respectively. The ETT was accurately placed in 75%, and lower birth weight was associated with a too deep tip position (p = 0.018). The optimal median (IQR) insertion depths were: ETT 5.5 (5.5-6.0); low UAC 6.0 (5.5-6.5); high UAC 9.6 (9.2-10.3), and UVC 5.5 (5.0-6.1) cm. ETT position was not associated with respiratory outcomes or mortality.

Conclusion: The suggested insertion depths can be expected to result in accurate positioning of ETTs and umbilical lines in infants born at 22-23 weeks gestation.

Impact: There is limited information to guide delivery room placement of endotracheal tube (ETT) and umbilical catheters (UC) in infants born at a gestational age (GA) of 22-23 weeks. An evaluation standardized insertion depths for ETT and UC, with use of x-ray based measurements of their positions, demonstrate the feasibility of using GA-based insertion depths. The suggested insertion depths can be expected to result in accurate ETT and UC tip positions in infants born at 22-23 weeks.