Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Resuscitation Science

Background:

• Extremely low birth weight (ELBW) infants often require resuscitation, including endotracheal intubation, shortly after birth.
• The success rate of initial intubation attempts in this vulnerable population can significantly impact outcomes.
• Establishing a stable airway quickly is crucial for neonatal survival and development.

Purpose of the Study:

• To determine the association between successful first-attempt endotracheal intubation and outcomes in ELBW infants.
• To quantify the importance of achieving a successful intubation on the first try during neonatal resuscitation.
• To evaluate the impact of intubation success on neurodevelopmental impairment and mortality.

Main Methods:

• Retrospective chart review of ELBW infants (<=1000g) born between 2007-2014.
• Inclusion criteria: intubation within 5 minutes of birth or heart rate <100 within 10 minutes.
• Multivariable logistic regression analysis adjusted for key neonatal factors.

Main Results:

• 88 ELBW infants were analyzed; 40% achieved successful first-attempt intubation.
• Infants requiring multiple intubation attempts had higher rates of death or neurodevelopmental impairment (53% vs. 29%).
• Successful first-attempt intubation was associated with significantly improved outcomes (aOR 0.4, P<0.05).

Conclusions:

• Successful endotracheal intubation on the first attempt is associated with improved neurodevelopmental outcomes in ELBW infants.
• This finding underscores the critical importance of prompt and effective airway management in neonatal resuscitation.
• Optimizing delivery room team composition and roles may enhance first-attempt intubation success rates.