Megan M Gray1, Jennifer A Rumpel2, Brianna K Brei3, Jeanne Alexandra Krick4, Taylor Sawyer1, Kristen Glass5, Stephen DeMeo6, James Barry7, Anne Ades8, Natalie Napolitano9, Lindsay Johnston10, Ahmed Moussa11, Phillip Jung12, Bin Huey Quek13, Ayman Abou Mehrem14, Jeanne Zenge15, Justine Shults16, Vinay Nadkarni17, Jae Kim18, Neetu Singh19, Alicia Tisnic20, Elizabeth Foglia21, Akira Nishisaki22. 1. University of Washington School of Medicine, Seattle, Washington, USA. 2. Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, USA. 3. Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA. 4. Madigan Army Medical Center, Tacoma, Washington, USA. 5. Penn State College of Medicine, Penn State Health, Hershey, Pennsylvania, USA. 6. Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA. 7. University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, Colorado, USA. 8. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 9. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 10. Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA. 11. Department of Pediatrics, University of Montreal, Montreal, Québec, Canada. 12. Department of Pediatrics, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. 13. Neonatology, KK Women's and Children's Hospital, Singapore, Singapore. 14. Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. 15. Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, USA. 16. Children's Hospital of Philadelphia, Ambler, Pennsylvania, USA. 17. Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 18. Perinatal Institute, Cincinnati, Ohio, USA. 19. Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA. 20. Alberta Children's Hospital, Alberta, Alberta, Canada. 21. Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 22. Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Abstract
INTRODUCTION: Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear. OBJECTIVE: To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets. METHODS: Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites. RESULTS: Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success. CONCLUSIONS: Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes.
INTRODUCTION: Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear. OBJECTIVE: To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets. METHODS: Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites. RESULTS: Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success. CONCLUSIONS: Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes.
Authors: Yuri Ozawa; Anne Ades; Elizabeth E Foglia; Stephen DeMeo; James Barry; Taylor Sawyer; Neetu Singh; Kristen Glass; Philipp Jung; Bin Huey Quek; Lindsay Johnston; Jae Kim; Natalie Napolitano; Justine Shults; Vinay M Nadkarni; Akira Nishisaki Journal: J Perinatol Date: 2019-04-02 Impact factor: 2.521
Authors: Elizabeth E Foglia; Anne Ades; Taylor Sawyer; Kristen M Glass; Neetu Singh; Philipp Jung; Bin Huey Quek; Lindsay C Johnston; James Barry; Jeanne Zenge; Ahmed Moussa; Jae H Kim; Stephen D DeMeo; Natalie Napolitano; Vinay Nadkarni; Akira Nishisaki Journal: Pediatrics Date: 2018-12-11 Impact factor: 7.124
Authors: Charles W Sauer; Juin Yee Kong; Yvonne E Vaucher; Neil Finer; James A Proudfoot; Mallory A Boutin; Tina A Leone Journal: J Pediatr Date: 2016-07-26 Impact factor: 4.406