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Am J Perinatol 2022; 39(07): 776-785
DOI: 10.1055/s-0040-1718577
Original Article

Association of Delivery Room and Neonatal Intensive Care Unit Intubation, and Number of Tracheal Intubation Attempts with Death or Severe Neurological Injury among Preterm Infants

Anthony Debay
1   Faculty of Medicine, McGill University, Montreal, Quebec, Canada
,
Sharina Patel
2   McGill University Health Center Research Institute, Montreal, Quebec, Canada
,
Pia Wintermark
2   McGill University Health Center Research Institute, Montreal, Quebec, Canada
3   Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
,
Martine Claveau
3   Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
,
François Olivier
3   Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
,
Marc Beltempo
3   Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
› Author Affiliations Funding M.B. holds an Early Career Investigator Grant from the CIHR Institute of Human Development, Child and Youth Health. A.D. received a scholarship from Dr. Clarke K. McLeod Memorial Scholarship, McGill University, Montreal, QC, Canada; Michael B. and Mary Elizabeth Wood Summer Research Bursary, McGill University, Montreal, QC, Canada.
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Abstract

Objective The study aimed to assess the association of tracheal intubation (TI) and where it is performed, and the number of TI attempts with death and/or severe neurological injury (SNI) among preterm infants.

Study Design Retrospective cohort study of infants born 23 to 32 weeks, admitted to a single level-3 neonatal intensive care unit (NICU) between 2015 and 2018. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1). Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3–4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess association between exposures and outcomes and to adjust for confounders.

Results Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with one TI attempt and 23% (27/117) among infants with >1 TI attempt. Overall, median number of TI attempts was 1 (interquartile range [IQR]: 1–2). Compared with no TI, DR TI (adjusted odds ratio [AOR]: 9.04, 95% confidence interval [CI]: 3.21–28.84) and NICU TI (AOR: 3.42, 95% CI: 1.21–10.61) were associated with higher odds of death and/or SNI. The DR TI was associated with higher odds of death and/or SNI compared with NICU TI (AOR: 2.64, 95% CI: 1.17–6.22). The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR: 0.95, 95% CI: 0.47–2.03).

Conclusion The DR TI is associated with higher odds of death and/or SNI compared with NICU TI, and may help identify higher risk infants. There was no association between the number of TI attempts and death and/or SNI.

Key Points

  • Delivery room intubation correlates with morbidity.

  • Less than 2 intubation attempts are not associated with IVH.

  • Provider training reduces intubation attempts.

Keywords

prematurity - brain injury - intraventricular hemorrhage - periventricular leukomalacia - delivery room - premedication

Supplementary Material



Publication History

Received: 17 April 2020

Accepted: 07 September 2020

Article published online:
19 October 2020

© 2020. Thieme. All rights reserved.

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