Foglia et al evaluated outcomes of neonatal intubations in the delivery room or NICU. The authors are from multiple institutions from around the world participating in the NEAR4NEOS registry.
Successful airway management was defined as endotracheal tube placed in the trachea with confirmation (by chest rise, auscultation, chest X-ray, carbon dioxide detection or second independent laryngoscopy).
Adverse outcomes:
(1) severe events
(2) non-severe events
(3) severe desaturation (oxygen saturation decline >= 20%)
Rates observed:
(1) intubation on first attempt: about 50%
(2) severe desaturation rate: 33-50% (depending on site)
(3) adverse event: 20%
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Adverse Event
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Description
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Severity
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esophageal intubation
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immediate recognition
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non-severe
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delayed recognition
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severe
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cardiac event
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compressions < 1 minute
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severe
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cardiac arrest
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severe
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emesis
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without aspiration
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non-severe
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with aspiration
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severe
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laryngospasm
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severe
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pneumothorax or pneumomediastinum
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severe
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direct airway injury
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severe
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hypotension requiring intervention
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severe
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dysrhythmia (including bradycardia)
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non-severe
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mainstem intubation
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non-severe
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gum, dental or lip trauma
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non-severe
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pain or agitation
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non-severe
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epistaxis
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non-severe
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Risk factors for adverse events:
(1) unstable hemodynamics
(2) multiple intubation attempts (will use >= 3 in the implementation)
(3) failure to use videolaryngoscope (use reduces risk)
(4) failure to use paralytic premedication (use reduces risk)
Risk factors for severe desaturation:
(1) sedative premedication
(2) attending level provider (vs neonatal fellow)
(3) multiple intubation attempts
