Time to desaturation in preterm infants undergoing endotracheal intubation

Radhika Kothari, Kate Alison Hodgson, Peter G Davis, Marta Thio, Brett James Manley, Eoin O'Currain, Radhika Kothari, Kate Alison Hodgson, Peter G Davis, Marta Thio, Brett James Manley, Eoin O'Currain

Abstract

Background: Neonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU.

Methods: Observational study at The Royal Women's Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks' postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%).

Results: Seventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26-29) weeks and birth weight 946 (773-1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14-32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24-44) s and to desaturation <60% was 56 (42-68) s. No episodes of bradycardia were seen.

Conclusions: This is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation.

Trial registration number: ACTRN12614000709640.

Keywords: neonatology; resuscitation.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of included patients.
Figure 2
Figure 2
Kaplan-Meier probability curves of the probability of desaturation after ceasing PPV. PPV, positive pressure ventilation; SpO2, peripheral oxygen saturation; s, second.
Figure 3
Figure 3
Change in peripheral oxygen saturation after ceasing PPV in premature infants undergoing elective intubation. PPV ceased at time 0. PPV, positive pressure ventilation; SpO2, peripheral oxygen saturation.

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