Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):243-247 | DOI: 10.5507/bp.2024.015

A stylet use may be beneficial for elective and rescue intubation of prematurely born infants < 30 weeks

Klara Dunajova1, Tereza Lamberska1, Truong An Nguyen1, Adam Kubica1, Petr Kudrna1, 2, Richard Plavka1
1 Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
2 Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic

Background: Recent studies have reported that using a stylet does not provide any advantages during intubation within a diverse infant population. Our research focuses on the issue, specifically in premature infants who undergo elective or rescue intubation (EI or RI) in the delivery room (DR).

Methods: We conducted a single-center retrospective observational study comparing the number of intubation attempts, the duration of intubation procedure until successful, and the rate of associated desaturations exceeding 20%. We derived outcomes from video recordings and performed statistical analyses.

Results: We have analyzed 104 intubation attempts in 70 infants with a mean gestational age and birth weight of 25±1.9 weeks and 736±221 grams, respectively; 39 of these attempts involved stylet use, and 65 did not. 75% of infants requiring intubation were less than 26 weeks of gestational age. The use of a stylet increased the rate of successful initial attempts [OR (95% CI) 4.3 (1.3-14.8), P=0.019], reduced the duration of the intubation procedure [median (IQR) seconds: 43 (30-72) vs 140 (62-296), P<0.001], and decreased the occurrences of desaturation exceeding 20% (13% vs 50%, P=0.003).

Conclusion: The benefits of using a stylet during rescue and elective intubations of premature infants in the delivery room outweigh the potential harms. Its use may be advantageous in settings where proactive approaches are implemented for periviable infants.

Keywords: delivery room, extremely premature infant, intubation, stylet

Received: March 14, 2024; Revised: April 17, 2024; Accepted: April 30, 2024; Prepublished online: May 28, 2024; Published: September 12, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Dunajova, K., Lamberska, T., An Nguyen, T., Kubica, A., Kudrna, P., & Plavka, R. (2024). A stylet use may be beneficial for elective and rescue intubation of prematurely born infants < 30 weeks. Biomedical papers, 168(3), 243-247. doi: 10.5507/bp.2024.015
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Govindaswami B, Nudelman M, Narasimhan SR, Huang A, Misra S, Urquidez G, Kifle A, Stemmle M, Angell C, Patel R, Anderson C, Song D, DeSandre G, Byrne J, Jegatheesan P. Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit. Biomed Res Int 2019;2019:5984305. Go to original source... Go to PubMed...
    2. Sauer CW, Kong JY, Vaucher YE, Finer N, Proudfoot JA, Boutin MA, Leone TA. Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants-A Retrospective Cohort Study. J Pediatr 2016;177:108-3. Go to original source... Go to PubMed...
    3. Singh N, Sawyer T, Johnston LC, Herrick HM, Moussa A, Zenge J, Jung P, DeMeo S, Glass K, Howlett A, Shults J, Barry J, Brei BK, Kim JH, Quek BH, Tingay D, Mehrem AA, Napolitano N, Nishisaki A, Foglia EE. National Emergency Airway Registry for Neonates (NEAR4NEOS). Impact of multiple intubation attempts on adverse tracheal intubation associated events in neonates: a report from the NEAR4NEOS. J Perinatol 2022;42(9):1221-7. Go to original source... Go to PubMed...
    4. Wozniak M, Arnell K, Brown M, Gonzales S, Lazarus D, Rich W, Katheria A. The 30-second rule: the effects of prolonged intubation attempts on oxygen saturation and heart rate in preterm infants in the delivery room. Minerva Pediatr 2018;70(2):127-2. Go to original source... Go to PubMed...
    5. Gray MM, Rumpel JA, Brei BK, Krick JA, Sawyer T, Glass K, DeMeo S, Barry J, Ades A, Napolitano N, Johnston L, Moussa A, Jung P, Quek BH, Mehrem AA, Zenge J, Shults J, Nadkarni V, Kim J, Singh N, Tisnic A, Foglia E, Nishisaki A. National Emergency Airway Registry for Neonates: NEAR4NEOS Investigators. Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS. Neonatology 2021;118(4):470-8. Go to original source... Go to PubMed...
    6. Kamlin CO, O'Connell LA, Morley CJ, Dawson JA, Donath SM, O'Donnell CP, Davis PG. A randomized trial of stylets for intubating newborn infants. Pediatrics 2013;131(1):198-5. Go to original source... Go to PubMed...
    7. O'Shea JE, Loganathan P, Thio M, Kamlin COF, Davis PG. Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings. Arch Dis Child Fetal Neonatal Ed 2018;103:F408-2. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content