Assessment of Endotracheal Tube Position after Oral Intubation in Neonates

INTRODUCTION: Endotracheal intubation remains a common procedure in both the delivery room and the neonatal intensive care unit. We aimed to determine the accuracy of this method of endotracheal tube (ETT) placement in our neonatal cohort.

METHODS: The data of infants requiring oral intubation were reviewed retrospectively. The initial ETT depth of insertion had been calculated in the Tochen rule. The initial depth was compared to the midtracheal region. The differences between the initial and ideal depth was calculated and divided by the midtracheal distance. Infants were placed into weight groups of ≤1000 g, 1001 to 2000 g, 2001 to 3000 g, and ≥3001 g.
RESULTS: We evaluated ETT placement in 160 neonates. Mean gestational age was 32.2 ± 4.4 weeks (23 to 41 weeks) and mean weight was 1989 ± 829 g (560 to 3800 g). The mean range of the difference between the initial depth and ideal depth to midtracheal distance was 0.39 ± 0.04, 0.35 ± 0.04, 0.46 ± 0.05, and 0.23 ± 0.04 in infants weighing ≤1000 g, 1001 to 2000 g, 2001 to 3000 g, and ≥3001 g, respectively (p=0,025). The differences between 2001-3000 g group and 1001-2000, also 2001-3000 g group and ≥3001 g group were statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: The 7-8-9 rule would be used to determine ETT length in neonates requiring intubation, particularly in those weighing more than 3 kg. As this rule has low accuracy for extremely very low birth weight neonates, its sensitivity may not be clear for neonates weighing below than 3 kg weight.