Neonatal intubation training: the patient comes first

Abstract

Premature babies that require resuscitation are highly vulnerable to poor outcomes, including death, intraventricular hemorrhage, and neurodevelopmental impairment. As a result, the early minutes of neonatal resuscitation are viewed as a “golden hour” requiring technical precision and choreographed teamwork. Sauer et al used their large database of resuscitation data to show that multiple intubation attempts, particularly in the smallest babies, dramatically increased rates of intraventricular hemorrhage. As trainees typically require more attempts while learning intubation, the data from Sauer et al also suggest that delivery room resuscitation of extremely preterm babies is a poor training environment for pediatric residents. Yet, the Accreditation Council for Graduate Medical Education continues to mandate proficiency in neonatal intubation, even as the number of opportunities fall and the stakes associated with the procedure rise. Although simulation can provide some support in learning intubation mechanics, it does not fully build competency. It is time to re-examine which trainees will truly require this skill and develop novel approaches to build expertise. In the meantime, intubation training should be confined to more mature, stable, and sedated neonates. Article page 108 ▶ Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants—A Retrospective Cohort StudyThe Journal of PediatricsVol. 177PreviewTo evaluate whether neonates exposed to multiple intubation attempts within the first 4 days after birth have an increased incidence of intraventricular hemorrhage (IVH). Full-Text PDF