Securing endotracheal tubes: does NeoBar availability improve tube position?

To assess if neonatal endotracheal tube (ETT) position improved with introduction of the NeoBar.

This retrospective study compared two cohorts of intubated neonates and their x-rays. During the first 2-month study period, ETTs were secured with tape only--the 'Tape-only' period; during the second study period, they were secured with a NeoBar (or tape if the NeoBar was unsuitable)--the 'NeoBar' period. ETT tip position was assessed subjectively as very high, high, OK, low, or very low; and objectively by vertebral body position and the ETT-tip-to-T1 distance.

During the Tape-only period, 59 babies had 275 x-rays with an ETT visible. During the NeoBar period, 67 babies had 331 x-rays with an ETT visible. There were 160 (58.2%) and 193 (58.3%) assessed as OK during the Tape-only and NeoBar periods, respectively (Fisher's Exact Test, P= 1.0). There were more very high tubes during the NeoBar period, and more low and very low tubes during the Tape-only period (Chi-squared test, P= 0.011). A similar trend was observed with the distribution of the ETT-tip-to-T1 distance (difference not statistically significant, Mann-Whitney test, P= 0.079).

During both time periods, less than two-thirds of ETTs were located in an acceptable position. For ETTs in unacceptable positions, there were more tubes in the higher positions during the NeoBar period, and more tubes in the lower positions during the Tape-only period. Further investigation is necessary to clarify if the differences in ETT position on x-ray correlate with relevant clinical outcomes.