TY - JOUR T1 - Time to desaturation in preterm infants undergoing endotracheal intubation JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed DO - 10.1136/archdischild-2020-319509 SP - fetalneonatal-2020-319509 AU - Radhika Kothari AU - Kate Alison Hodgson AU - Peter G Davis AU - Marta Thio AU - Brett James Manley AU - Eoin O'Currain Y1 - 2021/04/30 UR - http://fn.bmj.com/content/early/2021/04/29/archdischild-2020-319509.abstract N2 - Background Neonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU.Methods Observational study at The Royal Women’s Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks’ postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%).Results Seventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26–29) weeks and birth weight 946 (773–1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14–32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24–44) s and to desaturation <60% was 56 (42–68) s. No episodes of bradycardia were seen.Conclusions This is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation.Trial registration number ACTRN12614000709640All data relevant to the study are included in the article or uploaded as supplementary information. This was a secondary analysis of a randomised trial comparing two different facemask sizes used to deliver positive pressure ventilation to preterm infants prior to undergoing elective endotracheal intubation at The Royal Women’s Hospital (RWH), Melbourne, Australia. As part of this randomised trial, video recordings of the endotracheal intubations were collected. Data for this study Data were recorded in a paper-based Case Record From then entered into an electronic database (REDCap) ER -