Abstract
Objective:
To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.
Study Design:
A retrospective chart review was conducted for all ELBW infants ⩽1000 g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5 min of life or if intubation was attempted during the first 10 min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.
Results:
The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.
Conclusion:
Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.
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References
Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP et al. Neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2010; 122: S516–S538.
Kattwinkel J (ed). Textbook of Neonatal Resuscitation, 4th edn, American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program: Elk Grove Village, IL, USA, 2000..
O’Donnell CPF, Kamlin CO, Davis PG, Morley CJ . Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006; 117: e16–e21.
Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL . Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984; 12: 5010–5013.
Kelly MA, Finer NN . Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. J Pediatr 1984; 105: 303–309.
Friesen RH, Honda AT, Thieme RE . Changes in anterior fontanel pressure in preterm neonates during tracheal intubation. Anesth Analg 1987; 66: 874–878.
Raju TN, Vidyasagar D, Torres C, Grundy D, Bennett EJ . Intracranial pressure during intubation and anesthesia in infants. J Pediatr 1980; 96: 860–862.
Millar C, Bissonnette B . Awake intubation increases intracranial pressure without affecting cerebral blood flow velocity in infants. Can J Anaesth 1994; 41: 281–287.
Lane B, Finer N, Rich W . Duration of intubation attempts during neonatal resuscitation. J Pediatr 2004; 145: 67–70.
Leone TA, Rich W, Finer NN . Neonatal intubation: success of pediatric trainees. J Pediatr 2005; 146: 638–641.
Shah PS . Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol 2009; 29: 655–661.
Wyckoff MH, Salhab WA, Heyne RJ, Kendrick DE, Stoll BJ, Laptook AR . Outcome of extremely low birth weight infants who received delivery room cardiopulmonary resuscitation. J Pediatr 2012; 160: 239–244.
Handley SC, Sun Y, Wyckoff MH, Lee HC . Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol 2015; 35: 379–383.
Perlman JM, Risser R . Cardiopulmonary resuscitation in the delivery room. Arch Pediatr Adolesc Med 1995; 149: 20–25.
Lowe HJ, Ferris TA, Hernandez PM, Weber SC . STRIDE-An integrated standards-based translational research informatics platform. AMIA Annu Symp Proc 2009; 391–395.
Bayley N. Bayley Scales of Infant and Toddler development. 3rd edn. Harcourt Assessment: San Antonio, TX, 2006.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Diano D et al. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol Suppl 2007; 109: 8–14.
Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, Gantz MG, Walsh MC et al. Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med 2012; 367: 2495–2504.
SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med 2010; 362: 1959–1969.
Heinrich S, Torsten B, Ihmsen H, Irouschek A, Ackermann A, Cesnjevar R et al. Incidence and predictors of poor laryngoscopic view in children undergoing pediatric cardiac surgery. J Card Vasc Anesth 2013; 27: 516–521.
Elsmen E, Pupp IH, Hellstrom-Westas L . Preterm male infants need more initial respiratory and circulatory support than female infants. Acta Paediatr 2004; 93: 529–533.
Gargus RA, Vohr BR, Tyson JE, High P, Higgins RD, Wrage LA et al. Unimpaired outcomes for extremely low birth weight infants at 18 to 22 months. Pediatrics 2009; 124: 112–121.
Hauber LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D et al. Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation 2013; 84: 1359–1364.
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Wallenstein, M., Birnie, K., Arain, Y. et al. Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. J Perinatol 36, 112–115 (2016). https://doi.org/10.1038/jp.2015.158
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DOI: https://doi.org/10.1038/jp.2015.158
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