Journal
AMERICAN JOURNAL OF PERINATOLOGY
Volume 39, Issue 7, Pages 776-785Publisher
THIEME MEDICAL PUBL INC
DOI: 10.1055/s-0040-1718577
Keywords
prematurity; brain injury; intraventricular hemorrhage; periventricular leukomalacia; delivery room; premedication
Categories
Funding
- CIHR Institute of Human Development, Child and Youth Health
- Dr. Clarke K. McLeod Memorial Scholarship, McGill University, Montreal, QC, Canada
- Michael B. and Mary Elizabeth Wood Summer Research Bursary, McGill University, Montreal, QC, Canada
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The study assessed the association between the location and number of tracheal intubation attempts and death and/or severe neurological injury in preterm infants. The results showed that tracheal intubation performed in the delivery room was associated with a higher risk of death and/or SNI compared to intubation in the NICU. The number of intubation attempts did not have a significant association with death and/or SNI.
Objective The study aimed to assess the association of tracheal intubation (TI) and where it is performed, and the number of TI attempts with death and/or severe neurological injury (SNI) among preterm infants. Study Design Retrospective cohort study of infants born 23 to 32 weeks, admitted to a single level-3 neonatal intensive care unit (NICU) between 2015 and 2018. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1). Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess association between exposures and outcomes and to adjust for confounders. Results Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with one TI attempt and 23% (27/117) among infants with >1 TI attempt. Overall, median number of TI attempts was 1 (interquartile range [IQR]: 1-2). Compared with no TI, DR TI (adjusted odds ratio [AOR]: 9.04, 95% confidence interval [CI]: 3.21-28.84) and NICU TI (AOR: 3.42, 95% CI: 1.21-10.61) were associated with higher odds of death and/or SNI. The DR TI was associated with higher odds of death and/or SNI compared with NICU TI (AOR: 2.64, 95% CI: 1.17-6.22). The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR: 0.95, 95% CI: 0.47-2.03). Conclusion The DR TI is associated with higher odds of death and/or SNI compared with NICU TI, and may help identify higher risk infants. There was no association between the number of TI attempts and death and/or SNI.
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