![]() Today, infants routinely receive analgesia and sedation for surgical procedures in the operating room, but the extent to which infants routinely receive medication for other painful procedures varies. 2 This assumption has now been proven to be untrue. 1 This assumption that infants and children did not feel pain led to infants undergoing surgical and other painful procedures (e.g., lumbar puncture, endotracheal intubation) without any medication for pain and anxiety. The question now is if these video laryngoscope based intubations were performed by attending and not the trainees like resident and fellows as a part of learning, which otherwise also has higher chances of success with the procedure.Three decades ago, few scientists and health care providers believed infants and young children were able to localize and/or perceive painful stimuli. It’s been shown in previous studies and even in this paper that the success of intubation is also dependent on the training level of the provider. Further on multivariable analysis, the use of this technique had lower odds of adverse events with aOR 0.46 (CI 0.28-0.73), these numbers are promising. It appears that 21% NICU intubations were performed by using video laryngoscope. This study does not intend to study the impact of baseline saturation on the severe saturation desaturations, but something to consider with the available data.Īnother interesting outcome was the use of video laryngoscope in neonatal intubations. It brings an important question: if infants who have higher baseline saturation tolerated tracheal intubation better with less side effects especially fewer episodes severe desaturations. Though preoxygenation before intubation is not a standard practice, lots of institutes do keep baseline oxygen saturation higher than desired for the gestational age during intubation. The incidence of these events varied a lot amongst the participating center, 29-69%. I do have some questions and possible suggestions to the authors.Ĥ8% of the NICU intubations had Severe oxygen desaturation (>20% decrease in oxygen saturation from baseline). ConclusionsĬompliments to the author to establish the Neonatal Emergency Airway Registry for Neonates (NEAR4NEOS), and try answering the most fundamental questions during the tracheal intubation its characteristics and adverse events. Last, all of the participating NEAR4NEOS sites to date are academic centers study results may not reflect practice and outcomes of neonatal TI in community-based NICUs. Some practice measures that are protective against TIAEs (such as paralytic premedication) may not be appropriate for use during DR intubation. Analyses of factors associated with TIAEs and severe desaturations were confined to NICU intubations. 30, 31 An additional modification has been made in the NEAR4NEOS database to track longer-term patient outcomes of neonatal intubation. Other authors have reported an association between increased number of intubation attempts and adverse neurologic outcomes. ![]() We only collected data on adverse events that took place during the immediate airway management period. In addition, we did not collect data on the duration of intubation attempts, which may vary significantly across sites and may also be an important contributor to oxygen desaturations and adverse events. We undertook extensive training at each site before initiating data collection, but it is possible that reporting bias exists. Intubation success and adverse event outcomes were all collected via self-report. 27 Therefore, it may be prudent for some programs to preferentially offer neonatal intubation opportunities to trainees who will need this skill in their future practice, such as pediatric residents who will be responsible for attending DR resuscitations after graduation and neonatal fellows who have not reached procedural competence. 14 Given these changes, it is unlikely that most pediatric residents will acquire enough procedural exposure to become competent in neonatal intubation during their residency training. Intubation and tracheal aspiration are no longer recommended for infants born through meconium-stained amniotic fluid, 13 and noninvasive respiratory support is now prioritized for preterm infants. 25, 26 In addition, neonatal TI is less commonly performed because of significant practice changes over the last decade. One explanation for this decline is resident duty hour limitations and an increased reliance on nontrainee practitioners, such as hospitalists and nurse practitioners, to staff NICUs. 10, 23, 24 In a single-site study, Leone et al 7 found that the mean number of intubation attempts throughout training per resident declined from 38 to 12 over an 8-year period ending in 2002. Many authors have observed a decline in opportunities for residents to intubate in both the neonatal and pediatric population. Gestational age at birth, wk, median (IQR)
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