Intra-tracheal malposition of endotracheal tubes in newborns: a retrospective single-center study

to describe intra-tracheal tube malposition in newborns and evaluate potential predictors.

retrospective single-center study.

French quaternary referral hospital comprising 12 neonatal intensive care unit and 12 pediatric intensive care unit beds.

term newborns less than 28 days old and preterm newborns under 28 days corrected age, firstly intubated 01/01/2023 - 12/31/2023 irrespective of the intubation site.

endotracheal tube (ET) distal tip on first chest X-ray after intubation, blindly reviewed by two independent observers, and extensive data regarding intubation and first post-intubation chest X-ray.

one-hundred seventy-eight newborns were included, nearly half premature and half terms (median gestational age at intubation: 36 wk, IQR 28 - 40). Twenty-eight (15.7%) died within hospital discharge. Overall proportion of ET malposition was 63.5% (95% CI 56.4 - 70.6), including 17.4% mainstem intubations. Only weight at intubation was an independent determinant for ET malposition in a multivariate analysis (aOR 10.3; 95% CI 2.06 - 63.7 when intubation's weight was below 1000 g), with a strong trend between weight categories and ET malposition rates. However, ET malposition was not an independent risk factor for death (aOR 1.93; 95% CI 0.65 - 6.54).

intra-tracheal malposition of endotracheal tubes is extremely frequent in the neonatal population and can be prominently explained by a low weight at intubation implying a short trachea. Clear new strategies are mandatory to determine prior to intubation the ideal endotracheal tube depth marking and to accurately assess the intra-tracheal position of the tube after intubation.