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

Chun-Chih Peng,Chia-Hui Chen,Chyong-Hsin Hsu,Chia-Ying Lin,Mary Hsin-Ju Ko,Jui-Hsing Chang,Wai-Tim Jim,Ngiik-Ping Tiong,Hung-Yang Chang

doi:10.3389/fped.2020.00367

Chun-Chih Peng, Chia-Hui Chen + Show 7 more

Open Access

https://doi.org/10.3389/fped.2020.00367

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Abstract

Objective: 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.

Highlights

Establishing an effective artificial airway is pivotal to neonatal resuscitation
The oro-tracheal distance (OTD) were overestimated by nasal septum to ear tragus length (NTL) and underestimated by Neonatal Resuscitation Program (NRP)-gestational age (GA) and NRP-body weight (BW)
Our results showed that Tochen’s formula (TF) and NTL + 1 cm had similar mid-tracheal concordance, whereas the NRP tables more frequently resulted in shallow endotracheal intubations

Summary

Introduction

Establishing an effective artificial airway is pivotal to neonatal resuscitation. nearly one in four intubation attempts result in endotracheal tube tip (ETT) malpositioning [1]. Effective ETT placement is crucial to initiate resuscitation timely, expedite patient stabilization, and avoid complications, including oxygen desaturation, air leak syndrome, atelectasis and pulmonary hemorrhage [3,4,5,6]. The ETT should ideally be positioned within the mid-tracheal region [7]. Optimal placement may be affected by point of measurement references, neck position and respiratory phase, making an accurate determination of ETT position clinically challenging. The time to successful intubation may be as short as 30 s, the time to radiological confirmation of ETT position is usually much longer and may not always be feasible prior to emergency procedures, such as surfactant administration or inter-hospital neonatal transport [1, 8]

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