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Impact of multiple intubation attempts on adverse tracheal intubation associated events in neonates: a report from the NEAR4NEOS

Journal of Perinatology volume 42, pages 1221–1227 (2022)Cite this article

Subjects

Abstract

Objective

To determine the relationship between number of attempts and adverse events during neonatal intubation.

Study design

A retrospective study of prospectively collected data of intubations in the delivery room and NICU from the National Emergency Airway Registry for Neonates (NEAR4NEOS) in 17 academic centers from 1/2016 to 12/2019. We examined the association between tracheal intubation attempts [1, 2, and ≥3 (multiple attempts)] and clinical adverse outcomes (any tracheal intubation associated events (TIAE), severe TIAE, and severe oxygen desaturation).

Results

Of 7708 intubations, 1474 (22%) required ≥3 attempts. Patient, provider, and practice factors were associated with higher TI attempts. Increasing intubation attempts was independently associated with a higher risk for TIAE. The adjusted odds ratio for TIAE and severe oxygen desaturation were significantly higher in TIs with 2 and ≥3 attempts than with one attempt.

Conclusion

The risk of adverse safety events during intubation increases with the number of intubation attempts.

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Fig. 1
Fig. 2: Number of intubation attempts and outcome.

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Funding

This research was supported by NICHD R21 HD089151. Akira Nishisaki was supported by NICHD R21 HD089151 and AHRQ R18HS024511. EEF was supported by NICHD K23HD084727 and is a consultant for Medtronic. Natalie Napolitano was supported by NICHD R21 HD 089151 and AHRQ R18HS024511 and have research and/or consulting relationships with Drager, Actuated Medical, Smiths Medical, and VERO-Biotech. DGT is supported by a National Health and Medical Research Council (Australia) Investigator (Grant ID 2008212) and the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia).

Author information

Author notes

  1. These authors contributed equally: Akira Nishisaki, Elizabeth E. Foglia.

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital at Dartmouth, Lebanon, NH, USA

    Neetu Singh

  2. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Taylor Sawyer

  3. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA

    Lindsay C. Johnston

  4. Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Heidi M. Herrick

  5. Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada

    Ahmed Moussa

  6. Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA

    Jeanne Zenge & James Barry

  7. Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany

    Philipp Jung

  8. Division of Neonatology, Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, NC, USA

    Stephen DeMeo

  9. Division of Neonatology, Penn State College of Medicine, Hershey, PA, USA

    Kristen Glass & Ayman Abou Mehrem

  10. Department of Pediatrics, Section of Neonatology, University of Calgary, Calgary, AB, Canada

    Alexandra Howlett

  11. Department of Biostatistics and Clinical Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Justine Shults

  12. Department of Pediatrics, Division of Neonatology, University of Nebraska Medical Center, Omaha, NE, USA

    Brianna K. Brei

  13. Division of Neonatology, Perinatal Institute at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jae H. Kim

  14. KK Women’s and Children’s Hospital, Singapore, Singapore

    Bin Huey Quek

  15. Neonatal Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    David Tingay

  16. Department of Neonatology, Royal Children’s Hospital, Melbourne, VIC, Australia

    David Tingay

  17. Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia

    David Tingay

  18. Respiratory Therapy Department, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Natalie Napolitano

  19. Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Akira Nishisaki

  20. Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Elizabeth E. Foglia

Authors
  1. Neetu Singh
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  2. Taylor Sawyer
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  6. Jeanne Zenge
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  7. Philipp Jung
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  9. Kristen Glass
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  18. Natalie Napolitano
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  19. Akira Nishisaki
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  20. Elizabeth E. Foglia
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Consortia

National Emergency Airway Registry for Neonates (NEAR4NEOS)

  • Neetu Singh
  • , Taylor Sawyer
  • , Lindsay C. Johnston
  • , Heidi M. Herrick
  • , Ahmed Moussa
  • , Jeanne Zenge
  • , Philipp Jung
  • , Stephen DeMeo
  • , Kristen Glass
  • , Alexandra Howlett
  • , Justine Shults
  • , James Barry
  • , Brianna K. Brei
  • , Jae H. Kim
  • , Bin Huey Quek
  • , David Tingay
  • , Ayman Abou Mehrem
  • , Natalie Napolitano
  • , Akira Nishisaki
  •  & Elizabeth E. Foglia

Contributions

NS conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. All authors except JS coordinated and supervised data collection. JS and AN performed statistical analyses. All authors participated in data collection in their respective sites, interpreted the data and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Neetu Singh.

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Competing interests

The authors have no conflicts of interest to declare. JB and NS are the site principal investigator for aerosolized surfactant clinical trial phase 2b sponsored by Aerogen.

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Singh, N., Sawyer, T., Johnston, L.C. et al. Impact of multiple intubation attempts on adverse tracheal intubation associated events in neonates: a report from the NEAR4NEOS. J Perinatol 42, 1221–1227 (2022). https://doi.org/10.1038/s41372-022-01484-5

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