Neonatal Tracheal Intubation in the NICU: A Literature Review

This literature review explores factors influencing neonatal ICU intubation success, compares outcomes across settings, and identifies strategies to improve outcomes in this vulnerable population. A PubMed search was conducted using relevant keywords related to neonatal tracheal intubation. Studies published in English from 2000 to 2024 were included, with additional sources identified through manual bibliography reviews. Extracted findings were qualitatively synthesized by themes such as procedural outcomes, intubation setting, and provider training level. Nearly half of all neonatal tracheal intubations (TIs) are unsuccessful, with the rate of tracheal intubation adverse events (TIAEs) increasing with each additional attempt. First-pass success rates (FPSRs) correlate with provider experience, with attending physicians achieving the highest rates across all settings. Video laryngoscopy is associated with improved outcomes, particularly in neonates with difficult airways; however, direct laryngoscopy (DL) remains more commonly used. Premedication has been shown to reduce TIAEs and enhance FPSR, yet it remains underutilized in clinical practice. Standardized protocols, improved simulation-based training, and multidisciplinary strategies are essential to reduce complications. Future research should prioritize optimizing airway management and evaluating the impact of otorhinolaryngologist involvement, especially in difficult airway cases.