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Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight
  1. Madeleine C Murphy1,2,3,
  2. Veronica B Donoghue4,
  3. Colm Patrick Finbarr O’Donnell2,3
  1. 1 Department of Neonatology, The National Maternity Hospital, Dublin, Ireland
  2. 2 Children’s Clinical Research Unit, National Children’s Research Centre, Dubin, Ireland
  3. 3 School of Medicine, University College Dublin, Dublin, Ireland
  4. 4 Department of Radiology, The National Maternity Hospital, Dublin, Ireland
  1. Correspondence to Professor Colm Patrick Finbarr O’Donnell, Department of Neonatology, National Maternity Hospital, Dublin 2, Ireland; codonnell{at}


Background Endotracheal tube (ETT) tip position is determined on chest X-ray (CXR) and should lie between the upper border of the first thoracic vertebra (T1) and the lower border of second thoracic vertebra (T2). Infant weight is commonly used to estimate how far the ETT should be inserted but frequently results in malpositioned ETT tips. Palpation of the ETT tip at the suprasternal notch has been recommended as an alternative.

Objective To determine whether estimating ETT insertion depth using suprasternal palpation of the ETT tip rather than weight results in more correctly positioned ETT tips.

Design Single-centre randomised controlled trial.

Setting Level III neonatal intensive care unit (NICU) at a university maternity hospital.

Patients Newborn infants without congenital anomalies intubated in the NICU.

Interventions Participants were randomised to have ETT insertion depth estimated using palpation of the ETT tip at the suprasternal notch or weight [insertion depth (cm)=6 + wt (kg)].

Main outcome measure Correct ETT position, that is, between the upper border of T1 and lower border of T2 on CXR, determined by one consultant paediatric radiologist masked to group assignment.

Results There was no difference in the proportion of correctly placed ETT tips between the groups (suprasternal palpation 27/58 (47%) vs weight 23/60 (38%), p=0.456). Most incorrectly positioned ETTs were too low (56/68 (82%)).

Conclusion Estimating ETT insertion depth using suprasternal palpation did not result in more correctly positioned ETTs.

Trial registration number ISRCTN13570106.

  • infant
  • newborn
  • intubation
  • endotracheal
  • suprasternal palpation

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  • Contributors MCM contributed to study design, patient enrolment, trial implementation, data collection, data analysis and wrote and revised the manuscript. VBD determined the primary outcome and reviewed the manuscript. CPFO contributed to study design, patient enrolment, data analysis and revision of the manuscript.

  • Funding MCM is supported by a Clinical Research Fellowship from National Children’s Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland (R17637).

  • Competing interests None declared.

  • Ethics approval The study was approved by our Research Ethics Committee and registered with a clinical trials’ registry (ISRCTN13570106) before the first patient was enrolled.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.