Compression force on the upper jaw during neonatal intubation: mannequin study

Area of Science:

• Medical device safety
• Neonatal care
• Pediatric airway management

Background:

• Neonatal intubation is a critical but challenging procedure.
• Pressure-related injuries to neonatal oral structures have been documented.

Purpose of the Study:

• To quantify the pressure exerted on the upper jaw during neonatal tracheal intubation.
• To assess the potential for tissue injury from this pressure.

Main Methods:

• Neonatal mannequin intubation by multidisciplinary NICU providers.
• Pressure-sensitive film used to measure force on the upper jaw.
• Comparison of pressure, area, and time across different provider types.

Main Results:

• Mean pressure of 568 kPa (SD 78) was exerted on the upper jaw.
• Pressure exceeded 400 kPa in many attempts, surpassing the 250 kPa injury threshold.
• Laryngoscope contact with the upper jaw occurred in all intubation attempts.

Conclusions:

• Neonatal intubation applies significant, potentially injurious, compression forces to the upper jaw.
• Current laryngoscope design leads to contact with the upper jaw in all procedures.
• Brief but high-pressure exposure poses a risk for neonatal tissue injury.