• neonatology
• clinical procedures
• medical education

Videolaryngoscopy (VL) for intubation has been well studied in adults,1 but relatively less explored in neonates. A recent Cochrane review2 in neonates suggested possible role for VL in training. With increasing use of non-invasive ventilation, there is a need to ensure that less invasive surfactant administration (LISA) is performed to a high standard to ensure correct delivery of surfactant while allowing trainees to learn.

We introduced Storz C-MAC VL, with size 0 and 1 Miller blades for all LISAs and elective intubations in NICU to study feasibility and success of the procedures, along with effectiveness in improving operators’ confidence. All LISAs and elective intubations were performed using VL following unit guidelines. All operators were taught to use VL screen view and trained using simulation. Senior doctors experienced in intubation supervised all VL procedures. LISA was performed using specifically designed LISAcath (Chiesi Farmaceutici SpA, Italy).

In total, we studied 57 procedures (25 intubations and 32 LISAs) from January 2018 to February 2019. Tables 1 and 2 summarise the details of the procedures based on the operator’s experience and clinical characteristics of the babies respectively. Using VL, intubation was successful in 92% with 64% first-pass success, while LISA was successful in 94% with 47% first-pass success. The most common reason for an unsuccessful first attempt was an inability to advance the tubes despite a view of the cords due to large VL handle/blade, poor hand–eye coordination and difficult angle of insertion. Minor injury was reported on three occasions. Overall operator confidence scores increased post-procedure by 0.5–2 points (p=0.06) for intubations and by 1–3 points (p<0.004) for LISAs. Overall, VL use was recommended in 100% of intubations and 97% of LISAs.

Compared with adults, there are limited studies on use of VL in neonates and, to our knowledge, no other published study on LISA using VL. Despite a third of trainees being inexperienced, overall success rate was still higher compared with lower first-pass rate, with no significant complications. Despite the differences between VL and standard blades as highlighted by Kirolos and O’Shea,3 we have shown in our cohort that with training and supervision, it is feasible and safe to perform elective neonatal intubations and LISAs using currently available C-MAC VL blades in most babies. Improved operator confidence, particularly with LISA, and value of VL in checking correct tube placement have contributed to successful adaptation of this new practice in our unit.