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Original research
Predictors of successful neonatal intubation in inexperienced operators: a secondary, non-randomised analysis of the SHINE trial
  1. Kate Alison Hodgson1,2,3,
  2. Sharoan Selvakumaran1,
  3. Kate Louise Francis4,
  4. Louise S Owen1,2,3,
  5. Sophie E Newman5,
  6. Camille Omar Farouk Kamlin1,2,3,
  7. Susan Donath4,
  8. Calum T Roberts6,7,8,
  9. Peter G Davis1,2,3,
  10. Brett James Manley1,2,3
  1. 1Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, Victoria, Australia
  4. 4Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  5. 5Department of Neonatal Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  6. 6Department of Paediatrics, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  7. 7The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
  8. 8Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
  1. Correspondence to Dr Kate Alison Hodgson; Kate.Hodgson{at}thewomens.org.au

Abstract

Objective Neonatal endotracheal intubation is a lifesaving but technically difficult procedure, particularly for inexperienced operators. This secondary analysis in a subgroup of inexperienced operators of the Stabilization with nasal High flow during Intubation of NEonates randomised trial aimed to identify the factors associated with successful intubation on the first attempt without physiological stability of the infant.

Methods In this secondary analysis, demographic factors were compared between infants intubated by inexperienced operators and those intubated by experienced operators. Following this, for inexperienced operators only, predictors of successful intubation without physiological instability were analysed.

Results A total of 251 intubations in 202 infants were included in the primary intention-to-treat analysis of the main trial. Inexperienced operators were more likely to perform intubations in larger and more mature infants in the neonatal intensive care unit where premedications were used. When intubations were performed by inexperienced operators, the use of nasal high flow therapy (nHF) and a higher starting fraction of inspired oxygen were associated with a higher rate of safe, successful intubation on the first attempt. There was a weaker association between premedication use and first attempt success.

Conclusions In inexperienced operators, this secondary, non-randomised analysis suggests that the use of nHF and premedications, and matching the operator to the infant and setting, may be important to optimise neonatal intubation success.

Trial registration number ACTRN12618001498280.

  • Neonatology
  • Intensive Care Units, Neonatal
  • Respiratory Medicine

Data availability statement

Data are available upon reasonable request. The deidentified data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Proposals must undergo review by the Trial Steering Committee of the SHINE trial. Data will be made available for researchers who provide a methodologically sound research proposal as determined by the Trial Steering Committee following Human Research Ethics Committee review and receipt of a signed data access agreement.

https://doi.org/10.1136/archdischild-2024-327081

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    Data availability statement

    Data are available upon reasonable request. The deidentified data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Proposals must undergo review by the Trial Steering Committee of the SHINE trial. Data will be made available for researchers who provide a methodologically sound research proposal as determined by the Trial Steering Committee following Human Research Ethics Committee review and receipt of a signed data access agreement.

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    Footnotes

    • X @katehodg18, @calumtheroberts, @drbretty

    • Contributors KAH and SS conceptualised the study, collected data and drafted and edited the manuscript. KF and SD analysed the data and edited the manuscript. BJM, LSO, COFK, SEN, CTR and PGD collected data, assisted with study design and edited the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. KAH is the guarantor.

    • Funding Supported by grants from the National Health and Medical Research Council of Australia (Practitioner Fellowship #1157782 to PGD, Investigator Grants #2016662 to BJM, #1175634 to CTR). Vapotherm supplied the equipment for the main trial.

    • Competing interests None declared.

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