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Improving endotracheal tube placement in neonates
  1. Anip Garg1,
  2. Ajay Kumar Sinha1,2,
  3. Stephen Terence Kempley1,2
  1. 1 Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London, UK
  2. 2 Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Dr Anip Garg, Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK; dr.anipgarg{at}

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It was good to read Gill et al’s1 report on a carefully conducted randomised trial examining methods to estimate endotracheal tube (ETT) length. Together with their group’s previous trial,2 neither use of the vocal cord guide nor a gestation-based formula showed superiority over the traditional 7-8-9 rule (Tochen’s formula).

In this recent study, under half the infants had their ETT tip in the target radiographic position, despite being intubated in the neonatal unit, rather than immediately after birth. This success rate might reflect the methods used and also indicate that ETT intubation is a complex system requiring many elements to modify practice.

They noted that staff often secured the ETT lower than recommended. The tendency to push the tube in by an extra …

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