Optimal positioning of endotracheal tubes for ventilation of preterm infants.

Accurate knowledge of upper-airway dimensions is required to prevent malpositioning of endotracheal tubes in preterm infants. We measured vocal cord-carina, oral-carina, and nasal-carina distances in situ at autopsy of two groups of infants (less than 1000 and greater than or equal to 1000 g). In all 24 infants, crown-heel length, crown-rump length, and occipitofrontal circumference were better than weight in predicting upper-airway dimensions. Flexion of the neck decreased and extension increased both nasal-carina and oral-carina distances. Lateral rotation produced no significant changes. The postmortem data were not different from nasal-carina distances measured radiologically in 40 living, nasally intubated and ventilated infants, confirming the clinical validity of our findings. Regression equations were derived to predict optimal endotracheal tube lengths based on the external measurements of crown-rump length and crown-heel length.