Association of Delivery Room and Neonatal Intensive Care Unit Intubation, and Number of Tracheal Intubation Attempts with Death or Severe Neurological Injury among Preterm Infants

Debay, Anthony; Patel, Sharina; Wintermark, Pia; Claveau, Martine; Olivier, François; Beltempo, Marc

doi:10.1055/s-0040-1718577

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…The present study showed that EPT infants who were intubated in the delivery room had a higher risk of severe IVH and any grade IVH than those who were not. A retrospective cohort study in Canada showed that DRI was associated with higher odds of death and severe neurological injury compared with NICU intubation or no intubation among infants born at ≤ 28 gestational weeks 6 , which was consistent with our findings. A large retrospective cohort study in California showed that the differences in the results of DRI for severe IVH stratified by gestational age category (e.g., 24–25 gestational weeks, odds ratio 1.20, 95% CI 0.98–0.147; 26–27 gestational weeks, odds ratio 1.40, 95% CI 1.16–1.69) 5 .…”

Section: Discussionsupporting

confidence: 91%

“…We selected potential confounders on the basis of previous studies 5 , 6 , 26 . Child factors included gestational age (24, 25, 26, and 27 gestational weeks; categorical), birth weight (< 500, 500–749, 750–999, and ≥ 1,000 g; categorical), small for gestational age (dichotomous), sex (dichotomous), multiple births (dichotomous), facility-level at birth (tertiary, secondary, and others; categorical), birth year (2003–2008, 2009–2014, and 2015–2019; categorical), Apgar scores at 1 and 5 min (0–3, 4–6, and 7–10; categorical), placental transfusion (dichotomous), and RDS (dichotomous).…”

Section: Methodsmentioning

confidence: 99%

“…Reported risk factors for IVH include vaginal delivery, low Apgar score, respiratory distress syndrome (RDS), pneumothorax, hypoxia, hypercapnia, seizures, patent ductus arteriosus (PDA), thrombocytopenia, and infection 1 . Several studies showed that postnatal ventilatory management, including delivery room intubation (DRI), which has an important role in neonatal care, was associated with IVH among infants born very preterm (i.e., < 32 gestational weeks) 5 , 6 . The Committee on the Fetus and Newborn of the American Academy of Pediatrics recommended the initial use of continuous positive airway pressure in the delivery room rather than intubation 7 .…”

Section: Introductionmentioning

confidence: 99%

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Delivery room intubation and severe intraventricular hemorrhage in extremely preterm infants without low Apgar scores: A Japanese retrospective cohort study

Tamai,

Matsumoto,

Yorifuji

et al. 2023

Sci Rep

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The purpose of this study was to assess the associations between delivery room intubation (DRI) and severe intraventricular hemorrhage (IVH), as well as other neonatal outcomes, among extremely preterm infants without low Apgar scores using data from a large-scale neonatal registry data in Japan. We analyzed data for infants born at 24–27 gestational weeks between 2003 and 2019 in Japan using robust Poisson regression. Infants with low Apgar scores (≤ 1 at 1 min or ≤ 3 at 5 min) were excluded. The primary outcome was severe IVH. Secondary outcomes were other neonatal morbidities and mortality. The full cohort included 16,081 infants (intubation cohort, 13,367; no intubation cohort, 2714). The rate of DRI increased over time (78.6%, 2003–2008; 83.4%, 2009–2014; 87.8%, 2015–2019), while the rate of severe IVH decreased (7.1%, 2003–2008; 5.7%, 2009–2014; 5.3%, 2015–2019). Infants with DRI had a higher risk of severe IVH than those without DRI (6.8% vs. 2.3%; adjusted risk ratio, 1.86; 95% confidence interval, 1.33–2.58). The results did not change substantially when stratified by gestational age. Despite conflicting changes over time in DRI and severe IVH, DRI was associated with an increased risk of severe IVH among extremely preterm infants in Japan.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delivery room intubation and severe intraventricular hemorrhage in extremely preterm infants without low Apgar scores: A Japanese retrospective cohort study

Tamai,

Matsumoto,

Yorifuji

et al. 2023

Sci Rep

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“…There is some evidence from retrospective analyzes that successful first attempt intubation is associated with less intra-ventricular hemorrhage (IVH) in very preterm infants ( 17 ). Others did not observe this association but found DR intubations to be associated with higher odds of death and severe neurological injury when compared to NICU intubations ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Adverse Events and Unsuccessful Intubation Attempts Are Frequent During Neonatal Nasotracheal Intubations

et al. 2021

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Background: Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations.Objective: Aim of this study was to determine the frequency of tracheal intubation–associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit.Methods: This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded.Results: Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257–3.685) and equipment problems (OR = 3.43; 95% CI, 1.12–10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06–0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25–0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08–4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265–2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04–2.46) were associated with unsuccessful intubation attempts.Conclusions: In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.

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“…In theory, intubation in the delivery room generally suggests the newborn has a weak spontaneous breath or severe pulmonary diseases (such as severe RDS, and congenital diaphragmatic hernia). Consequently, intubation seems associated with many adverse outcomes during hospitalization [ 5 , 6 ]. Meanwhile, it has been described that pulmonary hemorrhage is caused by many triggers.…”

Section: Introductionmentioning

confidence: 99%

Intubation at Birth Is Associated with Death after Pulmonary Hemorrhage in Very Low Birth Weight Infants

Sun,

Qin,

Feng

et al. 2024

Children

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Objective: This retrospective cohort study was performed to clarify the association between intubation in the delivery room and the mortality after pulmonary hemorrhage in very low birth weight infants (VLBWIs) during hospitalization. Methods: The study participants were screened from the VLBWIs admitted to the neonatal intensive care unit (NICU) of the Children’s Hospital Affiliated to Nanjing Medical University from 31 July 2019 to 31 July 2022. The newborns who ultimately were included were those infants who survived until pulmonary hemorrhage was diagnosed. These subjects were divided into the intubation-at-birth group (n = 29) and the non-intubation-at-birth group (n = 35), retrospectively. Results: Univariate analysis found that the intubation group had a higher mortality and shorter hospital stay than the non-intubation group (p < 0.05) (for mortality: 25/29 (86.21%) in intubation group versus 14/35 (40.00%) in non-intubation group). By multivariate analysis, the result further showed that intubation in the delivery room was related to shorter survival time and higher risk of death (adjusted hazard ratio: 2.341, 95% confidence interval: 1.094–5.009). Conclusions: Intubation at birth suggested a higher mortality in the VLBWIs when pulmonary hemorrhage occurred in the NICU.

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Association of Delivery Room and Neonatal Intensive Care Unit Intubation, and Number of Tracheal Intubation Attempts with Death or Severe Neurological Injury among Preterm Infants

Cited by 10 publications

References 35 publications

Delivery room intubation and severe intraventricular hemorrhage in extremely preterm infants without low Apgar scores: A Japanese retrospective cohort study

Delivery room intubation and severe intraventricular hemorrhage in extremely preterm infants without low Apgar scores: A Japanese retrospective cohort study

Adverse Events and Unsuccessful Intubation Attempts Are Frequent During Neonatal Nasotracheal Intubations

Intubation at Birth Is Associated with Death after Pulmonary Hemorrhage in Very Low Birth Weight Infants

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