Comparison of Neonatal Intubation Practice and Outcomes between the Neonatal Intensive Care Unit and Delivery Room

被引:20
作者
Herrick, Heidi Meredith [1 ,2 ]
Glass, Kristen M. [3 ,4 ]
Johnston, Lindsay C. [5 ]
Singh, Neetu [6 ]
Shults, Justine [2 ]
Ades, Anne [1 ,2 ]
Nadkarni, Vinay [2 ,7 ]
Nishisaki, Akira [2 ,7 ]
Foglia, Elizabeth E. [1 ,2 ]
机构
[1] Childrens Hosp Philadelphia, Dept Pediat, Div Neonatol, 2nd Floor,Main Bldg 3401 Civ Ctr Blvd, Philadelphia, PA 19104 USA
[2] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
[3] Penn State Hlth Childrens Hosp, Dept Pediat, Div Neonatal Perinatal Med, Hershey, PA USA
[4] Penn State Coll Med, Hershey, PA USA
[5] Yale Univ, Dept Pediat, Yale Sch Med, Div Neonatal Perinatal Med, New Haven, CT 06520 USA
[6] Dartmouth Hitchcock Med Ctr, Dept Pediat, Div Neonatal Perinatal Med, Lebanon, NH 03766 USA
[7] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA
关键词
Delivery room; Intubation; Neonate; Neonatal intensive care unit; Newborn resuscitation; TRACHEAL INTUBATION; EVENTS; SAFETY;
D O I
10.1159/000502611
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: Characteristics of neonatal tracheal intubations (TI) may vary between the neonatal intensive care unit (NICU) and delivery room (DR). The impact of the setting on TI outcomes is not well characterized. Objective: The aim of this study was to define variation in neonatal TI practice between settings, and identify the association between setting and TI success and safety outcomes. Design: This was a retrospective cohort study of TIs in the National Emergency Airway Registry for Neonates from October 2014 to September 2017. The setting (NICU vs. DR) was the exposure of interest. The outcomes were first attempt success, course success, success within 4 attempts, adverse TI-associated events, severe desaturation, and bradycardia. We compared TI characteristics and outcomes between settings in univariable analysis. Factors significant in univariable analysis (p < 0.1) were included in a logistic regression model, with adjustment for clustering by center, to identify the independent impact of the setting on TI outcomes. Results: There were 3,145 TI encounters (2279 NICU, 866 DR) in 9 centers. Almost all baseline characteristics significantly varied between settings. First attempt success rates were 48% (NICU) and 46% (DR). In multivariable analysis, the setting was not associated with first attempt success. DR was associated with a higher adjusted OR (aOR) of success within 4 attempts (1.48, 95% CI 1.06-2.08) and a lower aOR for bradycardia (0.43, 95% CI 0.26-0.71). Conclusion: Significant differences in patient, provider, and practice characteristics exist between NICU and DR TIs. There is substantial room for improvement in first attempt success rates. These results suggest interventions to improve safety and success need to be targeted to the distinct setting.
引用
收藏
页码:65 / 72
页数:8
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