Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country
Background: This study assessed the success rate and associated complications of hospital-wide neonatal endotracheal intubations by pediatric residents and neonatal fellows using direct laryngoscopy. Secondary objectives were to identify characteristics and indications for the procedure in a tertiar...
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Elsevier
2022-03-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957221001753 |
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| author | Fai Saisamorn Chanoknan Sriwiset Ratree Sirisomboon Bosco Paes Ratchada Kitsommart |
| author_facet | Fai Saisamorn Chanoknan Sriwiset Ratree Sirisomboon Bosco Paes Ratchada Kitsommart |
| author_sort | Fai Saisamorn |
| collection | DOAJ |
| description | Background: This study assessed the success rate and associated complications of hospital-wide neonatal endotracheal intubations by pediatric residents and neonatal fellows using direct laryngoscopy. Secondary objectives were to identify characteristics and indications for the procedure in a tertiary-care center. Methods: A cross-sectional observational study was conducted. We prospectively collected performance and infant outcome data after neonatal intubation between March 1, 2019 and February 29, 2020. Results: 171 intubations were observed in 105 infants. The median infant gestational age was 31.0 weeks (interquartile range [IQR]: 27.5–36.0 weeks). Fifty infants (48%) were very low birth weight (VLBW, <1500 g; median 1640 g [IQR: 870–2420 g]). The most common indication for intubation was respiratory failure (65%). Pediatric residents and neonatal fellows had overall success rates of 66% and 98%, respectively. The success rate for the first intubation attempt was higher with more advanced pediatric residency training (P < 0.001). The median attempts for each intubation were 1 (IQR: 1–2) for both VLBW and non-VLBW infants (P = 0.48). The adverse outcome rates were 5% and 3% for VLBW and non-VLBW infants, respectively (P = 0.53). More than 2 intubation attempts was the only significant independent risk factor for adverse outcomes (adjusted odds ratio 6.7; 95% CI 1.3–33.6; P = 0.02). Conclusions: The success rate of pediatric residents for neonatal intubation was similar for VLBW and non-VLBW infants. The main indication was respiratory failure, and nearly half were infants with VLBW. To minimize adverse sequelae, written guidelines limiting the number of intubation attempts by junior trainees are warranted. |
| format | Article |
| id | doaj-art-75645d2f0bce4877936a79e533f9b301 |
| institution | DOAJ |
| issn | 1875-9572 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj-art-75645d2f0bce4877936a79e533f9b3012025-08-20T03:19:17ZengElsevierPediatrics and Neonatology1875-95722022-03-0163212513010.1016/j.pedneo.2021.09.001Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income countryFai Saisamorn0Chanoknan Sriwiset1Ratree Sirisomboon2Bosco Paes3Ratchada Kitsommart4Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandDivision of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandNursing Division, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandDivision of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, CanadaDivision of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Corresponding author. Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand.Background: This study assessed the success rate and associated complications of hospital-wide neonatal endotracheal intubations by pediatric residents and neonatal fellows using direct laryngoscopy. Secondary objectives were to identify characteristics and indications for the procedure in a tertiary-care center. Methods: A cross-sectional observational study was conducted. We prospectively collected performance and infant outcome data after neonatal intubation between March 1, 2019 and February 29, 2020. Results: 171 intubations were observed in 105 infants. The median infant gestational age was 31.0 weeks (interquartile range [IQR]: 27.5–36.0 weeks). Fifty infants (48%) were very low birth weight (VLBW, <1500 g; median 1640 g [IQR: 870–2420 g]). The most common indication for intubation was respiratory failure (65%). Pediatric residents and neonatal fellows had overall success rates of 66% and 98%, respectively. The success rate for the first intubation attempt was higher with more advanced pediatric residency training (P < 0.001). The median attempts for each intubation were 1 (IQR: 1–2) for both VLBW and non-VLBW infants (P = 0.48). The adverse outcome rates were 5% and 3% for VLBW and non-VLBW infants, respectively (P = 0.53). More than 2 intubation attempts was the only significant independent risk factor for adverse outcomes (adjusted odds ratio 6.7; 95% CI 1.3–33.6; P = 0.02). Conclusions: The success rate of pediatric residents for neonatal intubation was similar for VLBW and non-VLBW infants. The main indication was respiratory failure, and nearly half were infants with VLBW. To minimize adverse sequelae, written guidelines limiting the number of intubation attempts by junior trainees are warranted.http://www.sciencedirect.com/science/article/pii/S1875957221001753adverse eventsindicationsneonatesuccess ratetracheal intubation |
| spellingShingle | Fai Saisamorn Chanoknan Sriwiset Ratree Sirisomboon Bosco Paes Ratchada Kitsommart Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country Pediatrics and Neonatology adverse events indications neonate success rate tracheal intubation |
| title | Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country |
| title_full | Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country |
| title_fullStr | Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country |
| title_full_unstemmed | Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country |
| title_short | Indications and outcomes of neonatal intubation: A single-center, prospective study in a middle-income country |
| title_sort | indications and outcomes of neonatal intubation a single center prospective study in a middle income country |
| topic | adverse events indications neonate success rate tracheal intubation |
| url | http://www.sciencedirect.com/science/article/pii/S1875957221001753 |
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