Introduction: Complications of neonatal intubation are known to be increased with emergent intubations, increased number of attempts, unstable hemodynamics, or ventilation failure; and decreased with use of paralytic medication and videolaryngoscopy. Patient characteristics associated with complications are not well understood. Design/Methods: A retrospective cohort study was performed of neonates who underwent intubation between January 2017 and June 2019. Patient characteristics of infants with and without complications were compared. Complications included common adverse events and abnormal vital sign changes occurring during intubation.Results: A total of 467 intubation encounters in 352 infants were included with median gestational age (GA) at birth of 29 weeks, postmenstrual age (PMA) 33 weeks at intubation, and median weight 1795 g. 41.5% of infants had complications and 58.5% of infants did not. Infants with complications compared to infants without had a median FiO 2 of 0.50 versus 0.45 (p = .183), median GA at birth of 29 versus 31 weeks (p < .001), median PMA of 32 weeks versus 33.0 weeks (p = .352), median weight of 1540 g versus 1970g (p = .091), and median chronological age of 3 days versus 1 day (p = .001). Generalized Estimating Equations controlling for administration of paralytic indicated decreased complications in infants ≤21.5 days in chronological age (OR, 0.45; 95% CI, 0.30-0.69) and increased complications in infants ≤1565 g (OR, 1.52; 95% CI, 1.04-2.23). Conclusion:Patient characteristics associated with an increased rate of complications included chronological age and weight. Further study is needed to reduce complications.

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Objective This study aimed to evaluate the association between desaturation <60% (severe desaturation) during intubation and a total number of intubation attempts in the first week of life in very low birth weight (VLBW) infants with adverse long-term outcomes including bronchopulmonary dysplasia (BPD) and severe periventricular/intraventricular hemorrhage grade 3 or 4 (PIVH). Study Design A retrospective chart review was performed on VLBW infants intubated in the neonatal intensive care unit during the first week of life between January 2017 and July 2020. Descriptive tables were generated for two outcomes including BPD and PIVH. Multivariable logistic regression was performed for each outcome including significant predictors that differed between groups with a p-value of <0.2. Results A total of 146 patients were included. Patients with BPD or PIVH had a lower gestational age, and patients with BPD had a lower BW. Patients with BPD had a greater number of intubation attempts in the first week of life (4 vs. 3, p < 0.001). In multivariable logistic regression controlling for confounding variables, the odds developing BPD were higher for patients with increased cumulative number of intubation attempts in the first week of life (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.03–1.62, p = 0.029). Post hoc analyses revealed increased odds of developing BPD with increased number of intubation encounters in the first week of life (OR: 2.20, 95% CI: 1.04–4.82, p = 0.043). In this post hoc analysis including intubation encounters in the model; desaturation <60% during intubation in the first week of life was associated with increased odds of developing BPD (OR: 2.35, 95% CI: 1.02–5.63, p = 0.048). Conclusion The odds of developing BPD for VLBW infants were higher with increased intubation attempts and intubation encounters. In a post hoc analysis, the odds of developing BPD were also higher with desaturation during intubation. Further research is needed to determine mechanisms of the relationship between complicated intubations and the development of BPD. Key Points

Background: Identification of acute ischemic stroke patients (AIS) with large vessel occlusion (LVO) in the pre-hospital setting is paramount now that endovascular treatment has become the standard of care. Correctly identifying this AIS population will allow transport to appropriate stroke centers with endovascular stroke capabilities. Objectives: We choose to evaluate single symptoms which, if present, might signify an ischemic stroke with a LVO. We tested if the following stroke symptoms including hemiplegia, severe dysarthria, neglect, eye deviation were associated with a LVO. Our hypothesis is that the use of these selected single or multiple NIHSS symptoms will not result in a ROC of > 0.9 rendering it effective in LVO diagnosis. Methods: A retrospective cohort review was conducted of 551 AIS patients who presented to the emergency department over a 77 month period. Subject demographics clinical symptoms, and other pertinent information were collected from the medical record. The following symptoms at ED presentation were evaluated with univariate and multivariate regression and ROC curve analysis; hemiplegia (of arm and leg), dysarthria (severe), neglect, and eye deviation. Results: Out of the 551 patients, 220 (40%) had a moderate stroke (NIHSS >9) while 143 (26%) had a severe stroke (NIHSS>14) and 49% were male. The median NIHSS was 7 (IQR 4-15) and 228 (41%) had LVO on CTA. The odds ratio and area under the ROC curve for hemiplegia, severe dysarthria, neglect, and eye deviation were respectively OR 3.2 (2.2- 4.5), 3.2 (2.2- 4.6), 5.5 (3.4- 8.9), 7.7 (4.6- 13.1) and area under the ROC 0.63, 0.64, 0.63, and 0.64 respectively. The results of multivariate analysis were slightly better with an ROC of 0.72. Conclusions: Singular stroke symptoms do not have the diagnostic power to predict which patient with AIS will have a LVO. While they have positive odds ratios, the ROC analysis suggests that individually or in combination, they are not accurate enough to determine the presence of LVO.