Video laryngoscopy vs. direct laryngoscopy in infants and neonates: A systematic review and meta-analysis

Endotracheal intubation in infants and neonates is a critical yet challenging procedure with a narrow time window. This meta-analysis aimed to compare video laryngoscopy (VL) to direct laryngoscopy (DL) regarding first-attempt success, time to intubation, and complication rates.

We searched PubMed, Cochrane, and Embase databases and conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 2024, comparing VL and DL in infants less than one-year-old and neonates (defined as infants 0-28 days old). Primary outcomes included first-attempt success rate, while secondary outcomes were time to intubation (TTI) and complication rates. A subgroup analysis was performed for neonates.

In our analysis of 17 RCTs with 1918 participants, VL demonstrated a higher first-attempt success rate compared to DL (87.5 % vs 78 %; OR 2.13; p < 0.001), with similar results in neonates (77.6 % vs 63 %; OR 2.12; p = 0.027). VL also improved the time to best view (MD -2.85; p < 0.01) and showed significantly better POGO scores (MD 16.8; p < 0.01). However, there was no advantage of VL over DL in reducing time to intubation (MD 0.79; p = 0.49). VL reduced complications compared to DL (2.77 % vs 8.44 %; OR 0.33; p = 0.022).

This meta-analysis suggests that VL may improve first-attempt success and glottic visualization and may reduce complications compared with DL in infants and neonates. Intubation times appear similar between the two approaches. However, moderate heterogeneity, variability in VL devices, and potential operator dependence indicate that these findings should be interpreted with caution. Further clinical trials are warranted to validate these results and explore the long-term implications of VL on patient outcomes.