Improving neonatal intubation safety: A journey of a thousand miles

Sawyer, Taylor; Foglia, Elizabeth E.; Hatch, L. Dupree; Moussa, Ahmed; Ades, Anne; Johnston, Lindsay; Nishisaki, Akira

doi:10.3233/npm-171686

Cited by 56 publications

(40 citation statements)

References 47 publications

(65 reference statements)

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“…Neonatal tracheal intubation (TI) is a life-saving but potentially dangerous procedure. 1 The authors of studies of pediatric patients demonstrate that adverse events are common during TI, 2 -4 but adverse events have not been comprehensively characterized in the NICU and delivery room (DR) settings. Many studies of neonatal TI practice and outcomes were singlesite studies, had a relatively small number of infants enrolled, or were published >10 years ago.…”

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confidence: 99%

Neonatal Intubation Practice and Outcomes: An International Registry Study

et al. 2019

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for the NEAR4NEOS Investigators BACKGROUND AND OBJECTIVES: Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. METHODS:We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. Safety outcomes included adverse tracheal intubation-associated events (TIAEs) and severe oxygen desaturation (≥20% decline in oxygen saturation). We examined the relationship between intubation characteristics and adverse events with univariable tests and multivariable logistic regression. RESULTS:We captured 2009 NICU intubations and 598 DR intubations from 10 centers. Pediatric residents attempted 15% of NICU and 2% of DR intubations. In the NICU, the first attempt success rate was 49%, adverse TIAE rate was 18%, and severe desaturation rate was 48%. In the DR, 46% of intubations were successful on the first attempt, with 17% TIAE rate and 31% severe desaturation rate. Site-specific TIAE rates ranged from 9% to 50% (P < .001), and severe desaturation rates ranged from 29% to 69% (P = .001). Practices independently associated with reduced TIAEs in the NICU included video laryngoscope (adjusted odds ratio 0.46, 95% confidence interval 0.28-0.73) and paralytic premedication (adjusted odds ratio 0.38, 95% confidence interval 0.25-0.57). CONCLUSIONS:We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events. Our results will inform future interventional studies to improve neonatal intubation safety. abstract NIH WHAT'S KNOWN ON THIS SUBJECT: Endotracheal intubation is a critical skill in neonatology but is less frequently performed than in previous years because of changes in neonatal practice. Little is known about the current practice and safety outcomes of neonatal intubation in the academic setting. WHAT THIS STUDY ADDS:Pediatric residents rarely perform neonatal intubation. Only half of first intubation attempts are successful, and adverse events and severe oxygen desaturation are common. Paralytic premedication and video laryngoscopy are associated with decreased adverse events in the NICU.

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confidence: 99%

Neonatal Intubation Practice and Outcomes: An International Registry Study

et al. 2019

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“…After second failed attempt at direct laryngoscopy by a senior operator, VL helped improve glottis view and allowed intubation. Intubation in such neonates has been deemed to be difficult even by neonatologists who routinely intubate this group of patients [5]. It has been mentioned that they may require multiple attempts at intubation which can worsen their airway outcome, especially in patients with congenital anomalies [5].…”

Section: Case Reportmentioning

confidence: 99%

“…Intubation in such neonates has been deemed to be difficult even by neonatologists who routinely intubate this group of patients [5]. It has been mentioned that they may require multiple attempts at intubation which can worsen their airway outcome, especially in patients with congenital anomalies [5]. Videolaryngoscopy has been suggested as a measure to increase effectiveness at intubation in children [6].…”

Section: Case Reportmentioning

confidence: 99%

Anesthetic Management of a Neonate with OEIS Complex for Emergency Surgery: A Complex Challenge for Anesthesiologist!

Kamal

Gupta

2018

J Neonat Surg

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Omphalocele, exstrophy of cloaca, imperforate anus, and spinal defect (OEIS) complex is an extremely rare congenital anomaly (1:2,00,000–1:4,00,000) comprising of OEIS. The associated anomalies pose multiple challenges during the anesthetic administration. We are reporting anesthetic management of a baby born with this rare syndrome, posted for an emergency surgery on the 1st day of life. Anesthetic management of a neonate with this complex and difficult airway in this relation has never been discussed previously.

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“…7 These physician trainees may have received different amounts of training, experience, and technical instruction in neonatal intensive care. 9 The continued revision of pediatric resident duty hours prescribed by the ACGME has resulted in less availability of the pediatric resident workforce to care for patients in the NICU. 10,11 This trend has further reduced training time and skill acquisition of these trainees and has shifted much of the work of providing care in many NICUs onto other providers, such as pediatric hospitalists, NNPs, and PAs.…”

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confidence: 99%

Neonatal Provider Workforce

Keels

Goldsmith

Newborn³

2019

Pediatrics

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This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future. To meet the critical and complex health needs of preterm neonates and neonates who are ill in the NICU, collaborative teams of health care providers work to render timely, safe, effective, efficient, and evidencebased care. 1 Many NICU provider teams include neonatologists, advanced practice registered nurses (APRNs), physician assistants (PAs), pediatric hospitalists, neonatal fellows, and pediatric residents. 1 In collaboration, these providers work together to consistently provide high-quality care throughout the neonatal hospitalization. Training and licensure are different for the various NICU provider groups. Most APRNs and PAs working in NICUs have completed master's or doctoral degree programs that require the acquisition of certain cognitive abilities and technical skills aimed at producing safe and effective patient care. 2,3 Neonatal nurse practitioners (NNPs) and pediatric nurse practitioners (PNPs) are registered nurses with advanced education and training to enable them to care for neonatal, infant, and pediatric patients, respectively, as APRNs. 4 PAs are educated as medical generalists in programs that include pediatric and adult medicine. 5 After graduating from a master's-or doctoral-level academic program and achieving national certification and state licensure, APRNs and PAs typically complete medical staff credentialing and a period of orientation to the provider role in the NICU on the basis of demonstrated skill sets and competencies. Pediatric hospitalists are physicians who have completed a graduate medical school program as well as a pediatric residency program that requires proficiency and skills in all areas of pediatrics, including neonatal medicine. 6 A minimum number of months in the newborn nursery and NICU settings are required as part of any

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Improving neonatal intubation safety: A journey of a thousand miles

Cited by 56 publications

References 47 publications

Neonatal Intubation Practice and Outcomes: An International Registry Study

Neonatal Intubation Practice and Outcomes: An International Registry Study

Anesthetic Management of a Neonate with OEIS Complex for Emergency Surgery: A Complex Challenge for Anesthesiologist!

Neonatal Provider Workforce

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