16+ tricks for a successful NEONATAL endotracheal intubation!!!

A CHECK-LIST of items to consider when you're having a TOUGH time with a baby's intubation! How is the ETT inserted? How do you position yourself for an intubation? And the baby? What if the cords are super anterior? Do you always suction? Use a stylet? How can pre-medication and HFNC help? What if the cords are closed? Is your equipment functioning? Learn our recommendations here!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
NRP textbook 8th edition
Hodgson KA, Owen LS, Kamlin COF, Roberts CT, Newman SE, Francis KL, Donath SM, Davis PG, Manley BJ. Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. N Engl J Med. 2022 Apr 28;386(17):1627-1637. doi: 10.1056/NEJMoa2116735. PMID: 35476651.
Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics. 2010 Mar;125(3):608-15. doi: 10.1542/peds.2009-2863. Epub 2010 Feb 22. PMID: 20176672.
Steinhorn, R, De Ungria, M, Glob. libr. women's med.,(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10203
Hatch LD, Grubb PH, Lea AS, Walsh WF, Markham MH, Maynord PO, Whitney GM, Stark AR, Ely EW. Interventions to Improve Patient Safety During Intubation in the Neonatal Intensive Care Unit. Pediatrics. 2016 Oct;138(4):e20160069. doi: 10.1542/peds.2016-0069. Epub 2016 Sep 21. PMID: 27694281; PMCID: PMC5051203.
Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC Med Educ. 2018 Oct 3;18(1):230. doi: 10.1186/s12909-018-1338-4. PMID: 30285715; PMCID: PMC6171149.
O'Connell J, Weiner G Intubating extremely premature newborns: a randomised crossover simulation study BMJ Paediatrics Open 2017;1:e000157. doi: 10.1136/bmjpo-2017-000157
Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics. 2010 Mar;125(3):608-15. doi: 10.1542/peds.2009-2863. Epub 2010 Feb 22. PMID: 20176672.

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***TIMESTAMPS***
00:08 Attempt often
00:59 Find perfect view
01:57 Baby's level is ideal
02:39 Use curve of ETT
03:15 Use correct size blade
04:07 Intubate in 30 seconds
04:44 Baby is stable during attempt
05:18 Premeditate
05:48 Use readers
06:36 Try learning without a stylet
07:59 Be prepared for closed vocal cords
08:32 Be prepared for difficult intubations
09:37 Set up perfect environment
10:14 Avoid suction unless necessary
11:08 Make sure bulb is working
12:00 Do not trust pedicab blindly
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

[Kopiroti]

First tip makes me slightly emotional. Thank you for the words of encouragement

[ConnieLeFan]

Thanks for the education that all can afford!!

[Dibberntv]

I owe you the biggest thank you in the world!! I came in tonight to a difficult intubation. Our Neonatologist said, "man this kid is so anterior". Recalling your wonderful video from the previous day! I asked if she minded moving the head forward a little she said, "it's worth a try." And it worked!!!! She said she was going to remember that trick forever! Your detailed videos allow me to up my skills and knowledge. So thank you!
Vickie RRT (Indiana)

[thommy_kni]

Very helpful video and advices. Highly appreciate it. It is always the best to learn from an expert with a lot of experience. Thank you.

[vrwwlyr]

Hello Dr Tala, I just missed an intubation today and After Waschung your Video I know much better what I did wrong and what I could do better the next time. I was feeling down today and felt the embarrassment you talked about. Now, I do feel encouraged to try again.
Thank you!

[ronzrt]

Thank you. Appreciate the knowledge and great tips.

[dougdixon]

More please!! Thank you for your dedication!

[tobyrichards]

Hey Tala, great information. The other thing and was probably one of those things that I was taught was not to go directly into the mouth down the barrel of the blade. It will obscure the view, so I was always taught to bring the tube into the side of the mouth.
Next, like you said especially with the extremely low birth weight infants, I won't use a roll because they're already anterior and using a roll only pushes the cords more anterior

[amsmathew]

Thank u so much Mam, wish i had a teacher like u

[readiop]

These are all wonderful tips. Thanks Dr. Tala

[m.e.]

Thank you, these tips are so much appreciated & encouraging

[santhisri]

Thank you mam for your dedication!.more videos please!!

[PARAMEDICKSA]

Thank you very much. I benefited and enjoyed the method of explanation, Doc👋

[brahimihamid]

This is a great job doc .
I agree you from algeria .
Dr B ... ped surgeon 🎉❤

[tgaskill]

Excellent video! Dr. Tala, what are your thoughts on video laryngoscopy for neonatal intubations? I’m a Respiratory Therapist that trained on traditional laryngoscopy with adults and now use video laryngoscopy and find it really helpful in that population.

[remabuzeid]

Very helpful tips especially with glasses as last time I couldn't see Vocal cord easily due blurring 😢

[neoneo-czzh]

Super as usual sr Tala.please try to collect in a practical videos for intubation for more benefit . Thanks again so much

[mirmahmud]

Thank you so much for your nice video and excellent presentation. I am from Dhaka Bangladesh. I will try to get answers of my practical questions very few. How to do this if required as I am interested in paediatric patients.

[melishendek]

Thank you again. In europe we intubate generally nasal and not oral. Which advantage do have with your procedure? Yes, of course its pretty cool to have a "niv" during the intubation..

[aquascapebomahdi]

Great info appreciate the hard work
The problem with me is when intubating small babies 0-4 months oral opening to small i can see the glottis and the vocal cords but once i thread in the ett im blind every thing is obstructed and i fail any tips how to maximize the oral view making it easier to thread the ett comfortably