A new study published in the Archives
of Disease in Childhood, Fetal and Neonatal Edition showed that video laryngoscopy (VL) is
the standard of treatment for newborn intubations in the neonatal intensive
care unit (NICU) and delivery room because it increases intubation success
rates without increasing adverse effects.
Neonates’ distinct airway
architecture, low physiologic reserve, and quick propensity for hypoxemia
during attempts make urgent tracheal intubation one of the most technically
challenging operations in clinical practice. Clinicians have traditionally used
direct laryngoscopy, which necessitates a clear line of sight in order to see
the glottis.
However, a different method that provides an expanded, indirect
image of the airway through a camera-equipped blade has emerged with the advent
of video laryngoscopy. Neonates, whose tiny anatomical boundaries make
visibility challenging and even slight delays might jeopardize oxygenation, are
particularly drawn to this technique.
Although there are still
concerns regarding video laryngoscopy’s consistency across various gestational ages,
clinical settings, and operator skill levels, preliminary data indicates that
it may improve glottic vision and assist learners. Urgent intubations also
frequently take place in high-stress environments, such neonatal critical care
units or delivery rooms, when patient condition, team familiarity, and
equipment availability might affect effectiveness.
Neonatal teams’ training
priorities and airway management tactics can be improved by knowing the
relative advantages and disadvantages of these two approaches. Determining
whether video laryngoscopy should supplement or replace direct laryngoscopy
during urgent newborn intubation is still a crucial issue as technology
advances. Thus, this study was assessed the safety and
effectiveness of employing VL against direct laryngoscopy (DL) for neonatal
intubation in the NICU and delivery room (DR).
Up to August 2024, researchers
conducted unrestricted searches in Embase, MEDLINE, CINAHL, and the Cochrane
Central Register of Controlled Trials. RCTs, quasi-RCTs, cluster-RCTs, or
cross-over studies that contrasted video laryngoscopy with direct laryngoscopy for newborn intubation outside of
the neonatal operating room.
The key findings of this study
highlighted that with 849 intubations
(RR 1.46, 95% CI 1.21 to 1.75) and a number required to treat (NNT) of 6, video laryngoscopy increases first attempt intubation success rates. Overall, in both the neonatal unit and the delivery room, video laryngoscopy should be the standard of care for newborn intubation, especially in cases where the intubator lacks expertise.
Reference:
Donaldson, N., O’Donnell, C. P. F., Roehr, C. C., Adams, E., Bartle, D. G., Geraghty, L. E., Tinnion, R., & O’Shea, J. E. (2025). Video versus direct laryngoscopy for urgent tracheal intubation in neonates: a systematic review and meta-analysis. Archives of Disease in Childhood. Fetal and Neonatal Edition, 110(6), 526–531. https://doi.org/10.1136/archdischild-2024-327555