Training Opportunities for Intubation of Very Low Birthweight Infants in a Tertiary Neonatal Centre

Abstract

Aims
Endotracheal intubation is a mandatory skill for paediatric training in Ireland. There is international concern that trainees do not have sufficient opportunities to develop proficiency in intubation1. Advances in care, including increased use of non-invasive ventilation, have reduced rates of endotracheal intubation in preterm infants. The aim of this project was to quantify the training opportunities for intubation of very low birthweight (VLBW) infants in a tertiary neonatal intensive care unit (NICU).

Methods
This was a retrospective chart review of babies ≤1500g born in the Rotunda hospital between January–December 2023.

Results
A total of 101 babies were included, with a median gestational age of 25+6 weeks (23+1 – 32+5 weeks). There were 141 intubation episodes comprising 226 intubation attempts. 78/141 (55%) intubations were successful on first attempt. 102/141 (72.3%) intubations occurred in the NICU, and 65/141 (46.1%) happened during normal working hours. Surfactant was given in 67/141 (47.5%) and the baby remained intubated after surfactant in 108/141 cases (76.5%). Adverse events were documented in 15/141 episodes (10.6%).

Discussion
Despite falling preterm intubation rates worldwide, there remains ample opportunities for obtaining this skill in our unit. While increasing use of laryngeal mask airways (LMAs) for surfactant administration would impact these training opportunities, most babies receiving surfactant remained intubated and ventilated.