Physiologic changes associated with endotracheal intubation in preterm infants

Duration of intubation attempts during Neonatal Resuscitation

“…These studies did not have a uniform definition for an attempt and were longer than the durations reported from our current delivery room experience. 1,2 The shortest mean durations for neonatal nasotracheal intubations using a similar definition of duration, including our own previous trial, were 50 and 53 seconds in newborn infants who had received only atropine before intubation. 1,2 As noted, 20% of our intubations and 17% of the failed attempts required greater than 40 seconds despite our guidelines.…”

“…1 The original NRP guidelines recommended a limit of 20 seconds per attempt for neonatal intubation. Several studies evaluating the use of premedication have evaluated the duration of attempt for nasotracheal intubations performed in the NICU.…”

Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events

“…Associated adverse effects include laryngospasm, bronchospasm, haemodynamic changes, raised intracranial pressure and an increased risk of intracranial haemorrhage [13]. Such effects can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication [20].…”

Exogenous surfactant: intubated present, nebulized future?

“…Apneic events, transient hypoxia, oxygen saturations, bradycardia and alterations in blood pressure and intracranial pressure are also linked to intubation events. [25] For infants born outside level III units, intubation is likely to be performed by a provider infrequently exposed to the procedure, with increasing risk. Pediatric trainees showed poor competency in intubation skills.…”

“…Studies comparing nebulized vs. intratracheal surfactant and powered to examine not only respiratory outcomes but morbidities of prematurity such as mortality, chronic lung disease, retinopathy of prematurity, intraventircular hemorrhage and necrotizing enterocolitis are required to further evaluate nebulized efficacy. Since Marshall et al [25] reported transient desaturation episodes with administration, a long-term study of neurodevelopmental outcome should also be considered. To date, the only surfactant preparation with sufficient data to report retention of biological activity after nebulization is lucinactant-a synthetic preparation consisting of DPPC, palmitoyleleoyl, phosphatidyl glycerol, palmitic acid and KL4, a novel synthetic peptide similar to surfactant protein B.…”