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Abstract Body

Background: Neonatal endotracheal intubation is a critical procedure, but first attempt success rates are low and desaturation is common. Nasal high-flow (nHF), which delivers high gas flows via nasal cannulae, extends time to desaturation in healthy children and adults undergoing elective intubation under general anaesthesia.

Methods: This multicentre, randomised controlled trial compared nHF with standard care in neonates undergoing oral endotracheal intubation in the delivery room or neonatal unit. Intubations were randomised individually, and stratified by site, premedication use and postmenstrual age (<28 weeks; >28 weeks). The primary outcome was successful intubation on the first attempt without physiological instability (absolute decrease in peripheral oxygen saturation >20% from pre-intubation baseline, and/or bradycardia <100 bpm).

Results: 251 intubations in 202 infants were included in the primary intention-to-treat analysis. Infants had a median (interquartile range) postmenstrual age of 27.9 (26.3-32.1) weeks and weight of 920 (712-1499) grams at the time of intubation. Successful first attempt intubation without physiological instability occurred in 62/124 (50.0%) intubations in the nHF group, compared with 40/127 (31.5%) in the standard care group (adjusted risk difference 17.6%, 95% confidence interval 6.0% to 29.2%; number needed to treat for benefit 6 infants, 95% confidence interval 4 to 17 infants, Table 2). Successful intubation was more common in the nHF group than the standard care group (68.5% and 54.3% respectively; adjusted risk difference 15.8%, 95% confidence interval 4.3% to 27.3%).

Conclusions: The use of nHF during neonatal intubation improves the likelihood of first attempt successful intubation without physiological instability.