Elsevier

The Journal of Pediatrics

Volume 177, October 2016, Pages 108-113
The Journal of Pediatrics

Original Articles
Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants—A Retrospective Cohort Study

https://doi.org/10.1016/j.jpeds.2016.06.051Get rights and content

Objective

To evaluate whether neonates exposed to multiple intubation attempts within the first 4 days after birth have an increased incidence of intraventricular hemorrhage (IVH).

Study design

This is a retrospective cohort study of infants intubated during the first 4 days after birth. Infants had birth weights (BWs) less than 1500 g and were admitted to the neonatal intensive care unit (NICU) at the University of California, San Diego, between January 1, 2005, and July 30, 2009. A subgroup analysis was done for infants with BW less than 750 g.

Results

A total of 308 infants with BW <1500 g, including 102 with a BW <750 g, were intubated within the first 4 days of life. The number of intubation attempts was significantly greater in infants with a BW <750 g who had severe IVH compared with those with mild or no IVH (OR 1.395, 95% CI 1.090-1.786, P = .008). For infants with BW <1500 g, the number of intubation attempts in the delivery room was significantly greater for infants with severe IVH (OR 1.317, 95% CI 1.052-1.649, P = .016).

Conclusion

Increased intubation attempts were associated with increased incidence of severe IVH in infants with BW less than 750 g and in infants less than 1500 g who were intubated only in the delivery room. Prospective studies are needed to further evaluate the relationship between intubation attempts and severe IVH.

Section snippets

Methods

This was a retrospective cohort analysis of a prospectively collected database of inborn, VLBW, infants who were intubated in the first 4 days after birth and admitted to the neonatal intensive care unit (NICU) at the University of California, San Diego, between January 1, 2005, and July 30, 2009. The population was chosen because 90% of IVH occurs within the first 4 days after birth and 50% occurs within 24 hours after birth.8 Infants with any known grade of IVH before the first intubation

Results

A total of 308 VLBW infants (mean gestational age 26.9±  2.2 weeks) were intubated during the first 4 days after birth, including 102 infants with a BW of less than 750 g (mean gestational age 25.1 ± 1.7 weeks). Antenatal steroids were administered to more than 90% of the mothers in both groups. Demographic data are shown in Table I, and the results for risk factors significantly associated with severe IVH used for the multivariable analysis are shown in Table II.

A total of 188 infants were

Discussion

In this retrospective cohort study of VLBW infants, we found significant associations in 2 high-risk groups of infants: those with BW <750 g and VLBW infants who were only intubated in the DR. Infants with BW <750 g who had more than 3 intubation attempts were nearly 28 times more likely to have severe IVH. It was shown previously that lower BW and earlier gestational age increased the risk of IVH.9 This study supports the conclusion that extremely preterm infants are more sensitive to the

References (30)

  • A.G. Philip et al.

    Intraventricular hemorrhage in preterm infants: declining incidence in the 1980s

    Pediatrics

    (1989)
  • D. Wilson-Costello et al.

    Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s

    Pediatrics

    (2005)
  • N.J. Jain et al.

    Impact of mode of delivery on neonatal complications: trends between 1997 and 2005

    J Matern Fetal Neonatal Med

    (2009)
  • I. Adams-Chapman et al.

    Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion

    Pediatrics

    (2008)
  • M. Gleissner et al.

    Risk factors for intraventricular hemorrhage in a birth cohort of 3721 premature infants

    J Perinat Med

    (2000)
  • Cited by (80)

    • Brain Injury in the Preterm Infant

      2023, Avery's Diseases of the Newborn
    • Perinatal Transition and Newborn Resuscitation

      2023, Avery's Diseases of the Newborn
    • Diagnosis and management of neonatal respiratory distress syndrome in Japan: A national survey

      2023, Pediatrics and Neonatology
      Citation Excerpt :

      Thus, the threshold of FiO2 is not appropriate for reflecting lung biology in patients with RDS,11,24–26 and it could lead to unnecessary treatment, causing airway obstruction, bradycardia, desaturation, and economic burden.23,27,28 Moreover, surfactant administration requires tracheal intubation, which is associated with risk of intraventricular hemorrhage.6,7 In fact, the incidence of intraventricular hemorrhage in Japan is much lower than those in other developed countries.1

    • Pharmacologic Analgesia and Sedation in Neonates

      2022, Clinics in Perinatology
      Citation Excerpt :

      Although procedural skill is highly variable between providers of different experience levels and at different medical centers, tertiary care centers report success rates of less than half for endotracheal intubation attempts.25 The confluence of frequent physiologic adverse effects and repeated attempts results in increased morbidity, with both intraventricular hemorrhage and severe cognitive impairment, cerebral palsy, hearing impairment, visual impairment, or death at 18 to 22-month follow-up associated with multiple intubation attempts.26,27 Premedication with a foundation of safe and effective analgesic administration minimizes the risk of airway trauma and reduces physiologic instability.28

    View all citing articles on Scopus

    Funded by University of California, San Diego. The authors declare no conflicts of interest.

    View full text