• neonatology
• intensive care units
• neonatal
• respiratory medicine
• resuscitation

Intubation is a core skill for paediatric trainees. Videolaryngoscopy is increasingly used in neonatal units and is recommended as part of the recent British Association of Perinatal Medicine difficult airway guidance.1 Videolaryngoscopy is widely used in adult airway management.

We performed a telephone-based interview of all neonatal units across the UK to ascertain the ownership and use of a videolaryngoscope (VL) within the unit. We inquired about the level of unit, whether the unit had access to a VL and the brand used. We asked if VL was used in various clinical situations. We also asked the units their perceived barriers and challenges to use of videolaryngoscopy. If clinicians were uncertain, clinical directors for the unit were contacted by email.

We received responses from 169 of 200 neonatal units (84.5%). Overall, 63% (107/169) of the units have a VL. The availability of a VL was higher in neonatal intensive care units (NICU, 81%) than in local neonatal units (LNU, 56%) and special care baby units (SCBU, 53%).

Of those units with a VL, we analysed the usage in different scenarios and if usage varied depending on the level of the neonatal unit (figure 1). Sixty-nine per cent (74/107) of the units use the VL in simulation of intubation. Sixty per cent (64/107) use the VL in trainee supervision. Thirty-one per cent (33/107) of the units use their VL as first-line equipment when intubating. Sixty-three per cent (67/107) would use it as rescue if initial intubation attempts using direct laryngoscopy were unsuccessful. Seventy-nine per cent (84/107) would use the VL in difficult airway situations. Fifty-five per cent (59/107) would also consider using VL when delivering less invasive surfactant adminstration (LISA). The use of VL for trainee supervision and LISA was higher in NICUs than in LNUs and SCBUs.

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Figure 1

Ownership and use of a videolaryngoscope (VL) in UK neonatal units. LISA, less invasive surfactant adminstration; LNU, local neonatal unit; NICU, neonatal intensive care unit; SCBU, special care baby unit.

The brands used by units were C-MAC (41%), Accutronic (26%), GlideScope (18%), McGrath (8%), Airtraq (3%), Proact Medical (2%), Medan (1%) and Peak Medical (1%).

There appear to be many challenges to use of the VL. The most common obstacle to use of the VL was confidence and training of both junior and senior staff. In some units there was reluctance to move away from traditional methods. There were concerns that having learnt with a VL, trainees may struggle to use direct laryngoscopy subsequently. A previous study has suggested that if you learn with VL, anatomical structures are more easily recognised.2

Funding was highlighted as a barrier to purchase of a VL; two units purchased a VL using coronavirus-19 funding. There were concerns that the VL blade was too large for smaller babies; however, smaller VL blades have become available. Sterilisation and cleaning were also seen to be problematic. Some units also reported that they had access to a VL but it remained unused.

Many units in the UK have access to VL. Use varies depending on activity, with low use in routine intubations. There is higher availability in NICUs compared with LNUs and SCBUs; in our experience, VLs can be hugely beneficial in units with low rates of intubations.

Increased use of videolaryngoscopy for training and routine practice will improve confidence of its use.