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Routine use of videolaryngoscopy in neonatal unit
  1. Rosie Ives,
  2. Anne Beh,
  3. Tosin Otunla,
  4. Vennila Ponnusamy
  1. NICU, Ashford and St Peter’s Hospitals NHS Trust, Chertsey, UK
  1. Correspondence to Dr Vennila Ponnusamy, NICU, Ashford and St Peter's Hospitals NHS Trust, Chertsey KT16 0PZ, UK; Vennilaponnusamy{at}

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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.

Table 1

Characteristics of operator and supervisor for intubations and LISA procedures

Table 2

Clinical characteristics of babies who underwent videolaryngoscopy for intubations and LISA

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.


We would like to thank all our doctors, ANNPs and nurses for embracing the new quality improvement project and completing the feedback forms to share their views. We are extremely grateful to St Peter’s Neonatal Unit’s Little Roo Charity for proving funds to purchase the videolaryngoscope.



  • RI and AB are joint first authors.

  • Correction notice This paper has been updated since it was published online. The last author's surname was mis-spelt.

  • Contributors RI helped design the project and data collection spreadsheet, collected data, assisted in drafting the first manuscript and approved of the final manuscript as submitted. AB helped with data collection, analysed the sets of data, assisted in drafting the manuscript and approved of the final manuscript as submitted. TO helped with purchase of new videolaryngoscope, trained staff in videolaryngoscopy, assisted in drafting the manuscript and approved of the final manuscript as submitted. VP conceptualised and designed the quality improvement project, trained staff in videolaryngoscopy, co-drafted the initial manuscript with RI, analysed data with AB and approved of the final manuscript as submitted. VP is the guarantor of the study.

  • Funding Our Little Roo Charitable funds provided financial assistance to purchase the Storz C-MAC Videolaryngoscope with 2 blades.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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