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Original research
Video versus direct laryngoscopy for urgent tracheal intubation in neonates: a systematic review and meta-analysis
  1. Niall Donaldson1,
  2. Colm Patrick Finbarr O'Donnell2,3,
  3. Charles Christoph Roehr4,5,6,
  4. Eleri Adams7,
  5. David George Bartle8,
  6. Lucy Elizabeth Geraghty9,
  7. Robert Tinnion10,
  8. Joyce E O’Shea11,12
  1. 1 Neonatology, Royal Hospital for Children, Glasgow, UK
  2. 2 Neonatal Unit, National Maternity Hospital Neonatal Unit, Dublin, Ireland
  3. 3 University College Dublin School of Medicine, Dublin, Ireland
  4. 4 Faculty of Health Sciences, Translational Health Sciences, University of Bristol, Bristol, UK
  5. 5 Clinical Trials Unit, National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
  6. 6 Newborn Services, Women's and Children's Division, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  7. 7 Neonatal Unit, Oxford University Hospitals NHS Trust, Oxford, UK
  8. 8 Department of Child and women’s Health, Royal Devon and Exeter Hospital, Exeter, UK
  9. 9 Neonatology, National Maternity Hospital Neonatal Unit, Dublin, Ireland
  10. 10 Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
  11. 11 Department of Neonatal Medicine, Royal Hospital for Children, Glasgow, UK
  12. 12 ScotSTAR Scottish Neonatal Transport Service, Paisley, UK
  1. Correspondence to Dr Joyce E O’Shea; joyce.o'shea{at}ggc.scot.nhs.uk

Abstract

Introduction Intubation is most often performed electively by anaesthetists in controlled conditions in operating theatres. In neonates, however, it is most often performed by neonatologists or paediatricians in urgent circumstances in the neonatal intensive care unit (NICU) or delivery room (DR). Neonatal intubation is a difficult skill to learn and maintain, and success rates are suboptimal both in the NICU and DR. Video laryngoscopy (VL) has the potential to increase intubation success and safety as it may offer a better view of the airway, which can be shared by the intubator and other clinicians.

Objectives To compare the efficacy and safety of using VL to direct laryngoscopy (DL) for intubation of neonates in the NICU and DR.

Search methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL up to August 2024 without language restrictions.

Selection criteria Randomised controlled trials (RCTs), quasi‐RCTs, cluster‐RCTs or cross‐over trials that compared VL to DL for intubation of neonates outside of the neonatal operating theatre.

Main results VL improves first attempt intubation success rates, 849 intubations (RR 1.46, 95% CI 1.21 to 1.75), with a number needed to treat (NNT) of 6.

Conclusions VL improves intubation success rates without increasing adverse events and should be the standard of care for neonatal intubations in the NICU and DR.

  • Neonatology
  • Resuscitation
  • Intensive Care Units, Neonatal

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2024-327555

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @ccroehr, @oshea_jem

    • Contributors The first draft was written by ND. This was reviewed by all authors and suggestions proposed. Further drafts were written by ND and JEO’S. These were reviewed again by all authors. JEO’S contacted authors of the included studies to get further information. JEO’S is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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