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Am J Perinatol 2021; 38(07): 728-733
DOI: 10.1055/s-0039-3400982
Original Article

Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Özgün Uygur 
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Mehmet Yekta Öncel 
2   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, Turkey
,
Gülsüm Kadıoğlu Şimşek
3   Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
,
Nilüfer Okur
4   Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
,
Kıymet Çelik
4   Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
,
Özlem Bozkurt 
5   Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
,
Ebru Yücesoy
5   Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
,
Demet Terek
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
,
Meltem Koyuncu Arslan
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Yeliz Pekçevik
7   Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Melek Akar
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Özge Altun Köroğlu
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
,
Suna Oğuz
3   Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
,
Nilgün Kültürsay
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
› Author Affiliations Funding None.
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Abstract

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth.

Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2).

Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group).

Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth.

Keywords

endotracheal tube placement - intubation - nasal septum–tragus length - newborn

Note

This study was accepted as a poster presentation at the 34th International Workshop on Surfactant Replacement, SPIN, Parma, Italy, June 7–8, 2019.




Publication History

Received: 24 June 2019

Accepted: 19 October 2019

Article published online:
13 December 2019

© 2019. Thieme. All rights reserved.

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