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

Deeksha Gupta1, Poonam Singh2, Mayank Priyadarshi1

  • 1Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.

Indian Pediatrics
|April 8, 2026
PubMed
Summary
This summary is machine-generated.

Continuing non-invasive respiratory support during endotracheal intubation (ETI) in neonates maintained oxygen saturation (SpO2) but did not significantly improve the primary outcome of preventing physiological instability during the procedure.

Keywords:
BradycardiaEndotracheal intubationNeonatesPhysiological instabilityRespiratory support

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Area of Science:

  • Neonatal Intensive Care
  • Pediatric Critical Care
  • Respiratory Support

Background:

  • Endotracheal intubation (ETI) in neonates can lead to physiological instability (PI).
  • Maintaining non-invasive respiratory support during ETI is a proposed method to prevent PI.
  • Evidence regarding its effectiveness is conflicting.

Purpose of the Study:

  • To evaluate the effects of continuing pre-existing respiratory support during ETI in neonates.
  • To compare outcomes between neonates receiving respiratory support during ETI and those receiving standard care.

Main Methods:

  • Randomized controlled trial in a neonatal intensive care unit (NICU).
  • Inclusion of neonates (≥26 weeks) requiring ETI, stratified by gestational age.
  • Exclusion of neonates with bradycardia, severe congenital anomalies, or emergency intubation.
  • Primary outcome: successful first-attempt intubation without PI (desaturation or bradycardia).

Main Results:

  • 73.3% of neonates in the intervention group achieved the primary outcome vs. 62.7% in the control group (P=0.161).
  • Minimum SpO2 was significantly lower in the control group.
  • No significant differences in desaturation rates, bradycardia, or changes in regional cerebral oxygen saturation (rcSO2).

Conclusions:

  • Continuation of non-invasive respiratory support during ETI in neonates helps maintain SpO2.
  • This intervention did not lead to a significant improvement in the primary outcome of preventing physiological instability during ETI.