Advertisement

New Formula for Nasal Endotracheal Intubation in Extremely Low–Birth Weight Infants in the Emergency Transport Setting: The “Genoa Formula”

Published:December 15, 2020DOI:https://doi.org/10.1016/j.amj.2020.11.013

      Highlights

      • Nasal endotracheal intubation is a challenging procedure in extremely low–birth weight infants.
      • This is particularly true in the acute neonatal transport setting when a prompt radiologic confirmation of the tube position is not available.
      • We propose a new weight-based equation to obtain the midtracheal position of the endotracheal tube tip for nasal intubation of extremely low–birth weight infants (the “Genoa formula”).

      Abstract

      Objective

      The purpose of this study was to find a predictive equation for estimating the optimal nasal endotracheal tube insertion depth in extremely low–birth weight infants (ELBWs) requiring invasive ventilation in the critical care interfacility transport setting.

      Methods

      We retrospectively calculated the optimal tube insertion depth in a cohort of neonates ≤ 1,000 g born at our neonatal intensive care unit and nasally intubated within the first 24 hours of life from January 2019 to May 2020.

      Results

      A total of 75 ELBW infants were included, with a median gestational age of 26.6 weeks (range, 22.1-32.6 weeks) and a median birth weight of 780 g (range, 410-990 g). The linear regression of the estimated optimal endotracheal tube insertion depth showed a good correlation when plotted against weight (R2 = 0.491); thus, a new weight-based formula was obtained.

      Conclusion

      The proposed weight-based formula (the “Genoa formula”) may help in predicting optimal insertion depths for nasal intubation in ELBW neonates, especially when a prompt radiologic confirmation of the tube position is not available, as during neonatal critical care transport.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bellini C
        • Risso FM
        • Ramenghi LA.
        The impact of Italian regionalisation on transporting neonatal patients back from the neonatal intensive care unit to the referring level two unit.
        Acta Paediatr. 2017; 106: 1358
        • Bellini C.
        Endotracheal tube depth in premature newborns.
        Respir Care. 2019; 64: 491
        • Foglia EE
        • Ades A
        • Napolitano N
        • Leffelman J
        • Nadkarni V
        • Nishisaki A.
        Factors associated with adverse events during tracheal intubation in the NICU.
        Neonatology. 2015; 108: 23-29
        • Hatch LD
        • Grubb PH
        • Lea AS
        • et al.
        Endotracheal intubation in neonates: a prospective study of adverse safety events in 162 infants.
        J Pediatr. 2016; 168: 62-66.e6
        • Sanchez-Pinto N
        • Giuliano JS
        • Schwartz HP
        • et al.
        The impact of postintubation chest radiograph during pediatric and neonatal critical care transport.
        Pediatr Crit Care Med. 2013; 14: e213-e217
        • Bellini C
        • Turolla G
        • De Angelis LC
        • et al.
        Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting.
        Acta Paediatr. 2019; 108: 83
      1. Razak A, Faden M. Methods for estimating endotracheal tube insertion depth in neonates: a systematic review and meta-analysis [e-pub ahead of print]. Am J Perinatol. doi:10.1055/s-0039-3402747, accessed .

        • Pereira SS
        • Raja EA
        • Satas S.
        Weight-based guide overestimates endotracheal tube tip position in extremely preterm infants.
        Am J Perinatol. 2019; 36: 1498-1503
        • Sirisopana M
        • Saint-Martin C
        • Nan Wang N
        • Manoukian J
        • Nguyen LH
        • Brown KA
        Novel measurements of the length of the subglottic airway in infants and young children.
        Anesth Analg. 2013; 117: 462-470
      2. Available at: http://mobile.nicutools.org/. Accessed September 30, 2020.

        • Tochen ML.
        Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion.
        J Pediatr. 1979; 95: 1050-1051
        • Schmolzer GM
        • Roehr CC.
        Techniques to ascertain correct endotracheal tube placement in neonates (review).
        Cochrane Database Syst Rev. 2014; 9CD010221
        • Peterson J
        • Johnson N
        • Deakins K
        • Wilson-Costello D
        • Jelovsek JE
        • Chatburn R.
        Accuracy of the 7-8-9 rule for endotracheal tube placement in the neonate.
        J Perinatol. 2006; 26: 333-336
        • Kempley ST
        • Moreiras JW
        • Petrone FL.
        Endotracheal tube length for neonatal intubation.
        Resuscitation. 2008; 77: 369-373
        • Tatwavedi D
        • Nesargi SV
        • Shankar N
        • Mathias P
        • Rao Pn S.
        Efficacy of modified Tochen's formula for optimum endotracheal tube placement in low birth weight neonates: an RCT.
        J Perinatol. 2018; 38: 512-516
        • Leung C.
        Optimal insertion depth for endotracheal tubes in extremely low-birth-weight infants.
        Pediatr Crit Care Med. 2018; 19: 328-331
        • Spence K
        • Barr P.
        Nasal versus oral intubation for mechanical ventilation of newborn infants.
        Cochrane Database Syst Rev. 2000; 1999CD000948
      3. Maiwald CA, Neuberger P, Mueller-Hansen I, et al. Nasal insertion depths for neonatal intubation [e-pub ahead of print]. Arch Dis Child Fetal Neonatal Ed. doi:10.1136/archdischild-2020-319140, accessed .

      4. Nicutools Web App Version 1.927. Available at: https://nicutools.org/. Accessed September 30, 2020.