Abstract
Endotracheal forms an indispensable component of neonatal resuscitation. Due to very small tracheal length and other anatomical constraints, placement of Endotracheal Tube (ETT) accurately in a neonate has always been a difficult task. Despite various recent advances in neonatology, significant proportions of intubations are still inappropriately positioned. Malpositioned ETT are more likely to cause complications. These complications may become irreversible quite early in the course, particularly in preterm neonates. In this paper, we aim to elucidate various methods that aid in determining the accurate placement of an ETT in neonates.
Highlights
Birth asphyxia is an important preventable cause of morbidity and mortality especially in the developing countries
Endotracheal Tube (ETT) tip is palpated as it passes beneath the palpating finger placed in the suprasternal notch.(Figure 1)Jain et al carried out a Randomized Control Trial (RCT) comparing suprasternal palpation, with standard chest radiography to reassess the potential benefit of ETT palpation technique in neonates [26]
Direct visualization of ETT tip passing through the cords is the most reliable clinical sign ensuring intratracheal placement followed by improvement in heart rate
Summary
Birth asphyxia is an important preventable cause of morbidity and mortality especially in the developing countries. Laryngoscope has made endotracheal intubation more universally accessible almost becoming a part of the standard arsenal in the delivery room and Neonatal Intensive Care Unit (NICU) [4]. Due to short tracheal length and several anatomical constraints placement of Endotracheal Tube (ETT) accurately in a neonate has always been a herculian task. Manual ventilation with a few large breaths at birth may cause lung injury and blunt the effect of subsequent surfactant treatment. The immature lung may be vulnerable at birth because it lacks surfactant and because it is fluid-filled with little room for air entry [7]. Various methods that aid in determining the accurate placement of an ETT have been described.
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