Transtracheal ultrasound is a useful tool to confirm endotracheal intubation with an acceptable degree of sensitivity and specificity. It can be used in emergency situations as a preliminary test before final confirmation by capnography.

CRD 42017068028.

in Sweden) were exposed to modafinil during early pregnancy. Compared with pregnant women who had not taken modafinil, pregnant women who had taken modafinil were more often overweight or obese and had higher rates of smoking and diagnoses of narcolepsy, multiple sclerosis, and attention-deficit/hyperactivity disorder (Table ).Overall, the rate of major malformations in the unexposed group was 2.1% (n = 40 697). There were 3 modafinil-exposed infants diagnosed as having a major malformation, resulting in a prevalence rate of 2.6% and a crude risk ratio of 1.06 (95% CI, 0.35-3.26). When restricted to only filled prescriptions during the first trimester, 75 pregnancies were exposed and 1 modafinilexposed infant was diagnosed as having a major malformation (risk ratio, 0.44; 95% CI, 0.06-3.10).Discussion | In this study, modafinil use during early pregnancy was not significantly associated with increased risk of major malformations. The combined Norwegian and Swedish study population had a similar proportion of modafinilexposed pregnancies compared with the Danish study, allowing for more than double the number of exposed infants to be followed up. However, the 95% CIs estimated in this study overlap with those from the Danish study and allow for the possibility of a greater than 3-fold risk as previously reported. 4 The limitations include that filled prescriptions were used as a proxy for medication use; any nonuse of modafinil would bias the results toward the null. Overall, the absolute number of exposed infants and malformations was low, hindering rigorous analyses accounting for potential confounding factors.These results illustrate the need to focus on performing large and sufficiently powered studies for drug safety in pregnancy research, preferably from several countries, when exposures and outcomes are rare. 6