Neonatal Tracheal Intubation in the NICU: A Literature Review

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Anesthesiology

Background:

• Neonatal tracheal intubation (TI) is a common but challenging procedure in neonatal intensive care units (NICUs).
• High rates of intubation failure and adverse events are reported, impacting patient outcomes.
• Factors influencing success and strategies for improvement require comprehensive review.

Purpose of the Study:

• To review factors influencing neonatal tracheal intubation (TI) success.
• To compare TI outcomes across different clinical settings.
• To identify strategies for improving TI outcomes in neonates.

Main Methods:

• Literature review of PubMed-indexed studies (2000-2024) on neonatal tracheal intubation.
• Inclusion of English-language publications and manual bibliography reviews.
• Qualitative synthesis of findings categorized by procedural outcomes, setting, and provider training.

Main Results:

• Nearly 50% of neonatal TIs are unsuccessful, with adverse events increasing per attempt.
• First-pass success rates (FPSRs) are higher with experienced providers (attending physicians).
• Video laryngoscopy shows promise, especially for difficult airways, but direct laryngoscopy is more common; premedication is underutilized but beneficial.

Conclusions:

• Improving neonatal tracheal intubation (TI) success requires standardized protocols, enhanced simulation-based training, and multidisciplinary approaches.
• Provider experience and appropriate technology (e.g., video laryngoscopy) are crucial.
• Further research on airway management optimization and specialist involvement is warranted.