320 - Success rate of endotracheal intubation based on neonatal weight in the delivery room

Poster Number: 320
Publication Number: 320.348

Michael Wagner, Medical University of Vienna, Vienna, Wien, Austria; Akira Nishisaki, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States; Lisa Roessler, Medical University of Vienna, Vienna, Wien, Austria; Katharina Bibl, Medical University of Vienna, Vienna, Wien, Austria

Background: In the delivery room, adequate airway management is the most important intervention for achieving sucessful transition after birth. 5% of newborn infants require positive pressure ventilation. Despite different techniques to open the airway, endotracheal intubation may be necessary. This intervention must be performed by experienced providers as neonatal intubation is a high-risk intervention with estimated low first attempt success rates and risk of adverse events including e.g., bradycardia, esophageal intubation, and desaturation. Previous investigations of the NEAR4NEOS (National Emergency Airway Registry for Neonates) registry showed that only 46% of all intubations succeed at first attempt in the delivery room.

Objective: We aimed to investigate intubation success rates in preterm and term infants based on birth weight and to identify intubation characteristics correlated with higher first attempt success rates of neonatal intubation in the delivery room.

Design/Methods: For the intubation registry NEAR4NEOS (National Emergency Airway Registry for Neonates) data collection forms were completed from 10/2014 to 06/2022 at participating centers and were entered into a secure research electronic data capture tool hosted at the Children’s Hospital of Philadelphia. Primary outcome was first attempt success rate grouped by patient weight (< 500g, 500-999g, 1000-1499g, 1500-1999g, 2000-2499g, 2500-2999g, 3000-3499g, >3500g). Secondary outcomes were number of attempts and adverse events. Covariates included intubation method, tube, stylet use, device, gestational age, clinical indication and comorbidities and gender.

Results: There were 3,308 tracheal intubation encounters in 15 centers. 52.2% of all intubations were successful at first attempt. First attempt success was modeled via logistic regression using splines for the birth weight variable. When referenced to the median birth weight of 1330g, intubation success increased with higher birth weight, with a significant difference above 2900 to 3000g. Decreased weight had a stronger effect on intubation success. The odds for an intubation success at 500g were half of the odds of the reference birth weight.

Conclusion(s): Birth weight has a significant effect on intubation success (p< 0.0001). Intubation success decreased with lower birth weight.
Detailed results of primary and secondary outcome are still analyzed and will be presented at the conference together with a final conclusion.