Respiratory Stabilization for Successful Intubation in Neonates: A Randomized Controlled Trial

Maintenance of non-invasive respiratory support during endotracheal intubation (ETI) is a feasible intervention to prevent procedure-related physiological instability (PI) in neonates. However, the evidence for its use is conflicting. The present study evaluated the effects of continuing pre-existing respiratory support during ETI in neonates compared to standard care.

Neonates (≥ 26 weeks) requiring ETI in the neonatal intensive care unit (NICU) were randomized to undergo ETI either on respiratory support (intervention; n = 75) or in room air (control; n = 75) using a computer-generated variable block random sequence, stratified according to gestational age (< 32 weeks and ≥ 32 weeks). Neonates with bradycardia (heart rate, HR < 100/minute), life-threatening congenital anomalies and those requiring intubation on emergency basis, were excluded. The primary outcome was first attempt successful intubation without PI (defined as desaturation, absolute fall in peripheral oxygen saturation (SpO₂) by > 20% and/or bradycardia, heart rate (HR) < 100/minute). Secondary outcomes were first attempt successful intubation and its duration, number of attempts, changes in HR, SpO₂ and regional cerebral oxygen saturation (rcSO₂) and incidence of procedure-related adverse events.

The baseline maternal and neonatal variables were comparable between both groups. The primary outcome was achieved in 73.3% and 62.7% of the neonates in the intervention and control group, respectively [relative risk (95% confidence interval) 1.3 (0.7-1.7); P = 0.161]. Minimum SpO₂ was significantly lower, and its change from baseline was significantly higher in controls without any difference in the rates of desaturation, bradycardia and change in rcSO₂.

Continuation of pre-existing non-invasive respiratory support during ETI in neonates better maintained SpO₂ without any significant improvement in the primary outcome. .