Akira Nishisaki1, Elizabeth E Foglia2, Neetu Singh3, Taylor Sawyer4, Lindsay C Johnston5, Heidi M Herrick6, Ahmed Moussa7, Jeanne Zenge8, Philipp Jung9, Stephen DeMeo10, Kristen Glass11, Alexandra Howlett12, Justine Shults13, James Barry8, Brianna K Brei14, Jae H Kim15, Bin Huey Quek16, David Tingay17,18,19, Ayman Abou Mehrem11, Natalie Napolitano20. 1. Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 2. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 3. Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, NH, USA. neetu2u@gmail.com. 4. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA. 5. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA. 6. Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 7. Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada. 8. Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA. 9. Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany. 10. Division of Neonatology, Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, NC, USA. 11. Division of Neonatology, Penn State College of Medicine, Hershey, PA, USA. 12. Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, AB, Canada. 13. Department of Biostatistics and Clinical Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. 14. Department of Pediatrics, Division of Neonatology, University of Nebraska Medical Center, Omaha, NE, USA. 15. Division of Neonatology, Perinatal Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 16. KK Women's and Children's Hospital, Singapore, Singapore. 17. Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia. 18. Department of Neonatology, Royal Children's Hospital, Melbourne, VIC, Australia. 19. Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia. 20. Respiratory Therapy Department, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Abstract
OBJECTIVE: To determine the relationship between number of attempts and adverse events during neonatal intubation. STUDY DESIGN: A retrospective study of prospectively collected data of intubations in the delivery room and NICU from the National Emergency Airway Registry for Neonates (NEAR4NEOS) in 17 academic centers from 1/2016 to 12/2019. We examined the association between tracheal intubation attempts [1, 2, and ≥3 (multiple attempts)] and clinical adverse outcomes (any tracheal intubation associated events (TIAE), severe TIAE, and severe oxygen desaturation). RESULTS: Of 7708 intubations, 1474 (22%) required ≥3 attempts. Patient, provider, and practice factors were associated with higher TI attempts. Increasing intubation attempts was independently associated with a higher risk for TIAE. The adjusted odds ratio for TIAE and severe oxygen desaturation were significantly higher in TIs with 2 and ≥3 attempts than with one attempt. CONCLUSION: The risk of adverse safety events during intubation increases with the number of intubation attempts.
OBJECTIVE: To determine the relationship between number of attempts and adverse events during neonatal intubation. STUDY DESIGN: A retrospective study of prospectively collected data of intubations in the delivery room and NICU from the National Emergency Airway Registry for Neonates (NEAR4NEOS) in 17 academic centers from 1/2016 to 12/2019. We examined the association between tracheal intubation attempts [1, 2, and ≥3 (multiple attempts)] and clinical adverse outcomes (any tracheal intubation associated events (TIAE), severe TIAE, and severe oxygen desaturation). RESULTS: Of 7708 intubations, 1474 (22%) required ≥3 attempts. Patient, provider, and practice factors were associated with higher TI attempts. Increasing intubation attempts was independently associated with a higher risk for TIAE. The adjusted odds ratio for TIAE and severe oxygen desaturation were significantly higher in TIs with 2 and ≥3 attempts than with one attempt. CONCLUSION: The risk of adverse safety events during intubation increases with the number of intubation attempts.