Introduction: The physiological stress induced by tracheal intubation (TI) is associated with increased risk of neurological injury among very preterm infants. We aimed to assess the association of location where TI is performed and the required number of TI attempts with death and/or severe neurological injury (SNI) among very preterm infants.
Methods: Retrospective cohort study of 442 infants born 23-32 weeks, admitted to the Montreal Children's Hospital NICU 2015-2018. Data was collected from the Canadian Neonatal Network database and chart review. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1) among infants intubated in first 7 days. Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and 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 and 32% (31/97) among DR TI. Rate of premedication use for NICU TI was 97% (102/105). Overall, median number of intubation attempts was 1 [1-2]. Compared to no TI, TI in the NICU and in the DR were associated with higher odds of death and/or SNI (adjusted odds ratio [AOR] NICU TI vs. no intubation 3.39, 95% CI 1.20-10.53, DR TI vs no intubation, AOR 9.28, 95% CI 3.33-29.43). DR TI was associated with higher odds of death and/or SNI compared to NICU TI (AOR 2.73, 95% CI 1.23-6.35). The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR 0.99, 95% CI 0.47-2.09).
Conclusion: Among intubated infants, DR TI is associated with higher odds of death and/or SNI vs. TI in the NICU with premedication. Optimizing non-invasive ventilation in the DR may help reduce brain injury in preterm infants.
Sharina Patel– Research Coordinator, McGill University Health Center Research Institute
Pia Wintermark– Neonatologist, Assistant Professor, Montreal Children's Hospital, McGill University Health Center Research Institute
Martine Claveau– Neonatal Nurse Practitioner, Montreal Children's Hospital, McGill University Health Center Research Institute
François Olivier– Neonatologist, Assistant Professor, Montreal Children's Hospital
Safiya Soullane– Medical Student, McGill University
Marc Beltempo– Neonatologist, Assistant Professor, Montreal Children's Hospital, McGill University Health Center Research Institute