Measurement of Airway Length in Neonates Using Fiberoptic Bronchoscopy

Optimal positioning of the endotracheal tube is a crucial step in the airway management of neonates. Short airway length creates a narrow margin of safety and thus a higher chance of ETT malpositioning. Published literature reports airway length of 5-7.5 cm, which is primarily based on autopsy and radiologic studies. We decided to measure the airway length in neonates undergoing surgeries using flexible fiberoptic bronchoscopy (FFOB).

Sixty full-term neonates, scheduled for surgery under general anesthesia with endotracheal intubation, were included in the study. Neonates with airway anomalies and anticipated difficult airways were excluded. Airway length was measured using FFOB.

Sixty neonates were included in the study. The mean airway length ± SD was 3.85 ± 0.71 cm. The mean ± SD length in males was 3.87 ± 0.63 cm, and in females was 3.82 ± 0.86 cm. The Spearman rank correlation coefficient of airway length (cm) with age was 0.139, and for weight was 0.130.

Airway length is much smaller in neonates as compared to that reported in the literature. Airway dimensions need reassessment in this population in order to improve safety and effectiveness of neonatal intubation practices.