Abstract
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
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Neonatal intubations often require multiple attempts.
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Neonates frequently desaturate during intubation.
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Intubation attempts are positively associated with BPD.
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Severe desaturation may be positively associated with BPD.
Keywords
neonatal endotracheal intubation - intubation complications - adverse events - patient
safety - bronchopulmonary dysplasia - periventricular-intraventricular hemorrhage
- very low birth weight infants
