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Nasal insertion depths for neonatal intubation
  1. Christian Achim Maiwald1,2,
  2. Patrick Neuberger3,
  3. Ingo Mueller-Hansen1,
  4. Rangmar Goelz1,
  5. Jörg Michel4,
  6. Michael Esser5,
  7. Corinna Engel2,
  8. Axel R Franz1,2,
  9. Christian F Poets1
  1. 1 Department of Neonatology, University Children's Hospital Tubingen, Tubingen, Germany
  2. 2 Center for Pediatric Clinical Studies, University Hospital Tubingen, Tubingen, Germany
  3. 3 Department of Neonatology, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
  4. 4 Department of Pediatric Cardiology and Intensive Care Medicine, University Children's Hospital Tubingen, Tubingen, Germany
  5. 5 Division of Paediatric Radiology, Department of Radiology, University Children's Hospital Tubingen, Tubingen, Germany
  1. Correspondence to Christian Achim Maiwald, Department of Neonatology, University Children's Hospital Tubingen, Tubingen 72076, Germany; Christian.Maiwald{at}


Aim Data on the depth of nasal intubation in neonates are rare, although this is the preferred route in some countries. Therefore, recommendations on optimal nasal intubation depths based on gestational age (GA) and weight are desirable.

Methods We determined the distances between the middle of thoracic vertebrae 2 (T2) and the tip of the endotracheal tube in 116 X-rays from nasally intubated neonates. The intubation depth (tip to nostril distance) that was documented in the digital patient’s file was then corrected for this distance to reach an optimal nasal insertion depth. Results were plotted against the infant’s GA and weight.

Results GA-based and birthweight-based charts and formulas for the nasal intubation depth in infants with a GA between 24 and 43 weeks and body weight between 400 and 4500 g were created.

Conclusions Generated data may help in predicting optimal insertion depths for nasal intubation in neonates.

  • neonatology
  • intensive care
  • resuscitation

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  • Contributors CAM, ARF and CFP were involved in the study design. CAM, IM-H, JM and ME were involved in the data collection. CAM and CE analysed the data. CAM drafted the first version of the manuscript. ARF, CFP, PN and RG reviewed the manuscript with respect to clinical interpretation of the data. All authors have reviewed the manuscript and contributed to each draft version and approved the final version of the manuscript.

  • Funding This research project was enabled by a research funding from the Lyomark Pharma. Lyomark Pharma had no influence in the preparation of data or the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This retrospective data analysis was approved by the local Ethics Committee at the University Hospital Tuebingen, reference no 576/2019BO2 including a waiver for parental consent.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this data analysis are included in the article.