Failed Endotracheal Intubation and Adverse Outcomes Among Extremely Low Birth Weight Infants

MB Wallenstein; KL Birnie; YH Arain; W Yang; NK Yamada; LC Huffman; JP Palma; VY Chock; GM Shaw; DK Stevenson


J Perinatol. 2016;36(2):112-115. 

In This Article


During the study period, 378 ELBW infants were treated at our institution, of whom 88 met study inclusion criteria. Among these 88 infants who required intubation within 5 min of life or within 10 min of life if heart rate <100, 40% were intubated on the first attempt, 34% on the second attempt and 26% required three or more attempts. Infants intubated on the first attempt were more likely to be female (P<0.05). Other demographic and baseline characteristics were no different between the two groups (Table 1).

Results of delivery room, neonatal, and neurodevelopmental outcomes are shown in Table 2, Table 3 and Table 4. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts with adjusted odds ratio (aOR) 0.4, 95% confidence interval (CI) 0.1–1.0, P<0.05.

Estimated risks for the additional study outcomes were less statistically stable, but there were non-significant trends towards reduced risk of adverse delivery room and neonatal outcomes among infants intubated on the first attempt, including chest compressions after intubation attempt (aOR 0.4, 95% CI 0.1 to 1.4), use of epinephrine (aOR 0.4, 95% CI 0.1 to 2.4), IVH (aOR 0.4, 95% CI 0.1 to 1.4), PVL (aOR 0.2, 95% CI 0.02 to 1.5), NEC (aOR 0.2, 95% CI 0.05 to 1.2) and pneumothorax (aOR 0.5, 95% CI 0.1 to 2.7).

Given the differential success of first intubation by sex, we performed an additional analysis of the primary outcome stratified by sex and did not find a significant difference in risk reduction between males and females who were intubated on the first attempt.