PT  - JOURNAL ARTICLE
AU  - Taylor Sawyer
AU  - Elizabeth E Foglia
AU  - Anne Ades
AU  - Ahmed Moussa
AU  - Natalie Napolitano
AU  - Kristen Glass
AU  - Lindsay Johnston
AU  - Philipp Jung
AU  - Neetu Singh
AU  - Bin Huey Quek
AU  - James Barry
AU  - Jeanne Zenge
AU  - Stephen D DeMeo
AU  - Brianna Brei
AU  - Jeanne Krick
AU  - Jae H Kim
AU  - Vinay Nadkarni
AU  - Akira Nishisaki
ED  - ,
TI  - Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates
AID  - 10.1136/archdischild-2018-316336
DP  - 2019 Sep 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F461--F466
VI  - 104
IP  - 5
4099  - http://fn.bmj.com/content/104/5/F461.short
4100  - http://fn.bmj.com/content/104/5/F461.full
SO  - Arch Dis Child Fetal Neonatal Ed2019 Sep 01; 104
AB  - Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.Setting Ten academic NICUs.Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017.Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation.Results Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47–0.53).Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.