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

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.