Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Uygur, Özgün; Öncel, Mehmet Yekta; Şimşek, Gülsüm Kadıoğlu; Okur, Nilüfer; Çelik, Kıymet; Bozkurt, Özlem; Yücesoy, Ebru; Terek, Demet; Arslan, Meltem Koyuncu; Pekçevik, Yeliz; Akar, Melek; Köroğlu, Özge Altun; Oguz, SS; Kültürsay, Nilgün

doi:10.1055/s-0039-3400982

Cited by 11 publications

(19 citation statements)

References 16 publications

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“…We found that NTL significantly overestimated the OTD in term infants, which is consistent with the findings of Wang et al (22). However, a recent Turkish study reported different results, and found that NTL + 1 cm was more likely to overestimate OTDs in infants <1,500 g and those with a GA < 34 weeks (19). NTL also overestimated OTDs in the SGA infants in the current study.…”

Section: Shading Explanationsupporting

confidence: 92%

“…This also means that age had a greater influence on NTL than BW, which has never been reported in previous studies. The efficacy of NTL + 1 cm in other studies has been reported to be as low as 32.7%, and most of these studies have attempted to refine the efficacy of NTL estimates using BW adjustments (19,20,22). Following adjustments for age, there was a 110% improvement in the overall efficacy of NTL estimations and a reduction of over 20% in the rates of too-deep intubations.…”

Section: Shading Explanationmentioning

confidence: 99%

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Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

et al. 2020

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This study aimed to evaluate the efficacy of Tochen's formula [TF, body weight (kg) plus 6 cm], nasal septum to ear tragus length (NTL) + 1 cm, and Neonatal Resuscitation Program gestational age (NRP-GA) and body weight (NRP-BW)-based intubation table in estimating the oro-tracheal intubation length, and to improve the estimation efficacy using anthropometric measurements in Taiwanese neonates. Study design: This was a prospective observational study conducted at a neonatal intensive care unit in Taipei, Taiwan. One hundred intubated neonates were enrolled. The estimated intubation depth was defined as being mid-tracheal concordant if it placed the endotracheal tip between the upper border of the first and the lower border of the second thoracic vertebra. A linear regression model was used to analyze the relationships between mid-tracheal depth and body weight (BW), NTL and gestational age (GA), and to revise the NRP intubation tables using our results. Results: Overall, 56% of the neonates were born at a GA ≤ 28 weeks and 48% had a BW ≤ 1,000 g. The overall mid-tracheal concordance rates for TF, NTL + 1 cm, NRP-GA, and NRP-BW estimations were 51.0, 57.0, 15.0, and 14.0%, and in the infants with a BW ≤ 1,000 g 56.3, 56.3, 8.3, and 8.3%, respectively. Our revisions of the NRP intubation tables based on the anthropometric measurements of our participants improved the efficacy of BW, GA, and NTL estimations to 63, 44, and 61%, respectively. Conclusion: TF and NTL + 1 cm were more reliable than NRP intubation tables in predicting the neonatal mid-tracheal length in neonates of all BW and GA. Considering morphological differences secondary to ethnicity, we recommend using these tailored recommendations during neonatal resuscitation in Asian neonates.

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Section: Shading Explanationsupporting

confidence: 92%

Section: Shading Explanationmentioning

confidence: 99%

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

et al. 2020

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“…Our unpublished data showed using the NTL method for estimating ETT insertion depth in term and preterm infants result in 35% of correctly positioned ETT tips. The data is similar to the randomised20 and non-randomised21 studies that showed similar accuracy (32%–37%) with the NTL method for estimating ETT insertion depth. With 90% power and two-sided 5% significance, to detect an absolute increase of 15% in optimally positioned ETT tips using the gestational age method, we will require 454 participants.…”

Section: Methodssupporting

confidence: 82%

“…However, a randomised trial found no difference between gestational age and weight-based methods for estimating ETT insertion depth in newborns 15. Similarly, observational studies report the NTL method—the distance from nasal septum tip to ear tragus+1 cm—for estimating ETT insertion depth improves the proportion of optimally placed ETT tips in neonates,16–19 but no difference between the NTL method and weight-based method was found in a recent randomised trial 20…”

Section: Introductionmentioning

confidence: 96%

Randomised trial estimating length of endotracheal tube insertion using gestational age or nasal-tragus length in newborns: a study protocol

Razak¹,

Faden²,

Alghamdi

et al. 2022

BMJ Open

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IntroductionEndotracheal tube (ETT) insertion depth estimation is important for optimal placement of ETT tip and balanced ventilation of the lungs. Various methods are available to determine the ETT insertion depth. The Neonatal Resuscitation Programme recommends the gestational age and nasal-tragus length (NTL) methods for estimating ETT insertion depth during cardiopulmonary resuscitation. However, the prospective data comparing these two methods is lacking.Methods and analysisThis is an open-label multi-centre randomised controlled trial, where gestational age and NTL methods will be used to determine the initial ETT insertion depth in term and preterm infants that are less than 28 days old, requiring oral intubation in the delivery room or neonatal intensive care unit (NICU).Sites and sample sizeThe trial is aimed to recruit 454 infants over 3 years across tertiary level NICUs.OutcomesThe primary outcome includes an optimally positioned ETT, defined as an ETT tip between the upper border of the first thoracic vertebra and the lower border of the second thoracic vertebra. The outcome is assessed by a paediatric radiologist, who will be masked to the group assignment. Secondary outcomes are malpositioned ETT tips, pneumothorax, ETT repositioning, chronic lung disease, invasive ventilation days, and death.AnalysisData will be analysed using the intention-to-treat principle. The primary and categorical secondary outcomes will be compared using the χ2 test. Adjusted risk ratios of outcomes will be calculated along with 95% CIs through multivariable logistic regression analysis, including covariates deemed biologically to influence the outcomes.Ethics and disseminationThe study has been approved by the PNU Research Ethics Board (20-0148) and the respective ethical review boards of the participating centres. The results will be disseminated through conference meetings, social media platforms, and publications in scientific journals.Trial registration numberNCT04393337.

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“…The size and depth of the ETT are calculated using several methods (Table I). (83)(84)(85)(86)(87) The position of the ETT is confirmed by observing chest rise, auscultation for equal breath sounds and prompt increase in HR. Capnography or colorimetric detection of carbon dioxide may be used to ensure appropriate tracheal placement of the ETT, especially during the transport of an intubated newborn.…”

Section: Endotracheal Intubation and Laryngeal Mask Airway Endotracheal Intubationmentioning

confidence: 85%

Singapore Neonatal Resuscitation Guidelines 2021

Biswas¹,

Ho²,

Yip³

et al. 2021

smedj

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Neonatal resuscitation is a coordinated, team-based series of timed sequential steps that focuses on a transitional physiology to improve perinatal and neonatal outcomes. The practice of neonatal resuscitation has evolved over time and continues to be shaped by emerging evidence as well as key opinions. We present the revised Neonatal Resuscitation Guidelines for Singapore 2021. The recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force Consensus on Science and Treatment Recommendations (2020) and guidelines from the American Heart Association and European Resuscitation Council were compared with existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were derived after the work group discussed and appraised the current available evidence and their applicability to local clinical practice.

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Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Cited by 11 publications

References 16 publications

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

Randomised trial estimating length of endotracheal tube insertion using gestational age or nasal-tragus length in newborns: a study protocol

Singapore Neonatal Resuscitation Guidelines 2021

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