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Updated: Jan 11, 2026
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
Prospective evaluation of recommendations for nasal insertion depths in neonatal intubation: a prospective quality
Christian A Maiwald1,2, Nina Ott3,4, Frank Fideler5
1Department of Neonatology, University Hospital Tübingen, Tübingen, Germany Christian.Maiwald@med.uni-tuebingen.de.
Objective:
Recommendations on nasal intubation depths in term or preterm newborns are scarce, although this is the preferred route in some countries. Postmenstrual age (PMA) and weight-based recommendations were recently published by our group.
Design:
A prospective quality assurance study SETTING: Single-centre study (University Children's Hospital Tübingen) PATIENTS: All nasally intubated term and preterm infants between August 2021 and August 2023 INTERVENTIONS: Physicians were free to choose the method of orientation for the insertion depth (our recommendations vs other's (eg, endotracheal tube (ETT) tip markers)). Subsequently, chest X-rays were performed. Correct ETT placement was defined as the tip visible between thoracic vertebrae 1-3. X-ray investigators were blinded to the method of orientation.
Main Outcome Measures:
Main outcome was the rate of correct ETT placements using our previous recommendation compared with other orientations. Secondary, a subgroup analysis for infants <1000 g and a comparison of PMA-based orientations by European Resuscitation Council (ERC) guidelines were performed.
Results:
114 intubations/infants were analysed (39 weight-based; 26 PMA-based; 49 others). Median PMA (IQR) was 30 0/7 weeks (26 6/7-35 0/7), weight 1310 g (793-2300). Correct ETT placement was in 74% following our recommendations versus 55% in others (p=0.046). No difference was seen between PMA-based and weight-based recommendations (77 vs 69%; p=0.57). 48 infants <1000 g showed even clearer results; based on ERC guideline, correct placement would have been 27%.
Conclusions:
Our previously published recommendations for nasal intubation depths are applicable in routine care leading to a more accurate ETT placement than with other orientations.
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