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Updated: Apr 1, 2026
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Optimal endotracheal tube insertion depth in infants with birth weights under 500 grams
Kyusang Yoo1, Soo Hyun Kim2, Jung Il Kwak1
1Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Objective:
Develop a birth anthropometry-based model to estimate initial endotracheal tube (ETT) insertion depth for infants with birth weight <500 g.
Study Design:
Retrospective single center cohort (2010-2025) including infants with birth weight <500 g, intubated on day 0 and underwent a postintubation chest radiograph. Adequate depth was defined as lip-to-tip placement between the upper border of T1 and the lower border of T2. Linear and quadratic models using birth weight and length were compared; the final model was presented as a bedside nomogram.
Result:
Eighty-two infants met the inclusion criteria. Birth weight and length independently predicted radiograph-derived optimal depth (p < 0.001). A combined quadratic model showed the strongest fit (adjusted R² = 0.70), outperforming single parameter rules.
Conclusion:
In neonates <500 g, a quadratic weight-length model improves the prediction of radiograph-defined midtracheal ETT depth and offers a practical bedside guide for initial placement.
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