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
. 2025 Jul 30.
doi: 10.1007/s13312-025-00136-z. Online ahead of print.

Estimation of Depth of Endotracheal Tube Insertion Using Gestational Age, Body Weight or Nasal-Tragus Length in Newborns: An Open-Label Randomized Controlled Trial

Abhishek Yadav  1 , Suksham Jain  2 , Ravinder Kaur  3 , Deepak Chawla  1 , Supreet Khurana  1 , Harshit Kumar  1 , Mahima Rajan  1 , Hemant Gupta  1 , Yaseer Ahmad Mir  1
Affiliations

Estimation of Depth of Endotracheal Tube Insertion Using Gestational Age, Body Weight or Nasal-Tragus Length in Newborns: An Open-Label Randomized Controlled Trial

Abhishek Yadav et al. Indian Pediatr. .

Abstract

Objectives: Optimal placement of an endotracheal tube (ETT) tip is necessary for safe and effective ventilation of the lungs. However, there is no consensus on the most accurate method for calculating the depth of ET insertion. To compare the accuracy (proportion of optimally placed ETT) of nasal-tragus length (NTL)-based formula, body weight-based formula, and gestational age (GA)-based method in estimating the depth of oral ETT insertion in neonates.

Methods: Neonates of gestational age 250/7-41+6 weeks undergoing oral endotracheal intubation during the first 28 days of life were randomized into one of three study groups. The depth of ETT insertion was determined using gestational age-based (Kempley), weight-based (Tochen), or NTL-based methods. The optimal position of the ETT tip, assessed by a blinded radiologist on an anteroposterior chest radiograph, was considered to be between the upper border of T1 and the lower border of T2.

Results: In this study, 165 neonates (55 per group) were included. Birth weight, gestational age, proportion of small-for-gestational age neonates, and other baseline characteristics were similar among neonates in the three groups. The rates of optimal ETT placement were not significantly different between the NTL- (47.2%), GA- (45.4%) and weight-based (43.6%) methods (P = 0.911). The corresponding rates of ETT repositioning in the NTL-, GA- and weight-based method groups based on auscultation of chest was 58%, 49% and 29%, respectively (P < 0.001).

Conclusion: No significant difference was observed in the accuracy of the three methods studied. Better methods are needed to calculate the depth of ETT insertion.

Trial registration: Prospectively registered with the Clinical Trial Registry of India (CTRI/2022/12/048221).

Keywords: Birth weight; Gestation; Intubation; Neonate.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: None. Ethical approval: Institute Ethics Committee Ref No: GMCH/IEC/792 R/2022/122 dated Nov 18, 2022.

Similar articles

See all similar articles

References

    1. Pediatrics AAo, Association AH, Textbook of Neonatal Resuscitation (NRP) 8th ed. American Academy of Pediatrics: 2021
    1. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, et al. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics. 2010;126:443–56. - PubMed
    1. Kuhns LR, Poznanski AK. Endotracheal tube position in the infant. J Pediatr. 1971;78:991–6. - PubMed
    1. Yu VY, Wong PY, Bajuk B, Szymonowicz W. Pulmonary air leak in extremely low birthweight infants. Arch Dis Child. 1986;61:239–41. - PubMed - PMC
    1. Joshi VV, Mandavia SG, Stern L, Wiglesworth FW. Acute lesions induced by endotracheal intubation. Occurrence in the upper respiratory tract of newborn infants with respiratory distress syndrome. Am J Dis Child. 1972;124:646–9. - PubMed