Normative Data of Optimally Placed Endotracheal Tube by Point-of-care Ultrasound in Neonates

ObjectiveTo derive normative data of the distance between optimally placed endotracheal tube tip and arch of aorta by ultrasound in neonates across different weight and gestation.DesignCross-sectional study.SettingTertiary care neonatal intensive care unit from April 2015 to May 2016.ParticipantsAll neonates requiring endotracheal intubation were eligible for the study.MethodsDuring intubation, insertional length was determined using weight-based formula. The distance between endotracheal tube tip and arch of aorta was measured by ultrasound. Endotracheal tube position was confirmed by chest radiograph.ResultsOut of 133 enrolled infants, 101 (75.9%) had optimally placed endotracheal tubes. The mean (SD) distance between endotracheal tube tip and arch of aorta by ultrasound was 0.78 (0.21) cm in infants <1500 g and 1.04 (0.32) cm in infants 1500 g. The regression equation to estimate insertional length from weight, crown heel length (CHL), occipito-frontal circumference (OFC), nasal tragus length (NTL) and sternal length (SL) were Wt(kg)+4.95, 0.15xCHL(cm)+0.57, 0.22xOFC(cm)+0.49, 0.82x NTL(cm)+1.24 and 0752xSL(cm)+2.26, respectively.ConclusionOur study reports normative data of the distance between optimally placed endotracheal tube tip and arch of aorta by ultrasound in neonates. The distance between endotracheal tube tip and arch of aorta increases with increase in weight and gestation. Insertional length correlates strongly with all the anthropometric parameters.